Detection and treatment of drug resistance in extrapulmonary tuberculosis(EPTB)is a major challenge worldwide.Drug resistance in EPTB has not been studied extensively.However,patients with drug-resistant EPTB have bee...Detection and treatment of drug resistance in extrapulmonary tuberculosis(EPTB)is a major challenge worldwide.Drug resistance in EPTB has not been studied extensively.However,patients with drug-resistant EPTB have been reported to have poor outcomes[1].Rifampicin and isoniazid are the cornerstone drugs in the management of EPTB.Resistance in Mycobacterium(M.)tuberculosis to these drugs commonly arises due to mutations in the‘rpoB’gene and‘katG&inhA’genes,which confer resistance to rifampicin and isoniazid,respectively.Treatment outcomes are affected by the presence of these mutations.In addition,anatomical and physiological barriers impede the effective delivery of drugs to the affected extrapulmonary site[1].An analysis of the frequency of mutations in drug resistant M.tuberculosis strains causing EPTB in our region can help identify patterns of drug resistance.This,in turn,can provide inputs that may be used for modifying standard treatment regimens to make them more effective.The present study aims to identify the frequency and pattern of mutations in the‘rpoB’gene and‘katG&inhA’genes in M.tuberculosis strains isolated from EPTB samples.展开更多
Tuberculosis(TB)remains a critical global health challenge,with 10.8 million new cases and over 1.25 million deaths reported annually,disproportionately affecting low-income regions.Despite its use,the Bacillus Calmet...Tuberculosis(TB)remains a critical global health challenge,with 10.8 million new cases and over 1.25 million deaths reported annually,disproportionately affecting low-income regions.Despite its use,the Bacillus Calmette-Guérin(BCG)vaccine provides limited protection against adult pulmonary TB,necessitating novel solutions.The messenger RNA(mRNA)vaccine technology,proven effective in combating coronavirus disease 2019,offers significant promise for TB prevention.These vaccines elicit robust immune responses by encoding antigens that stimulate humoral and cell-mediated immunity,essential for combating mycobacterium TB.Unlike traditional methods,mRNA vaccines are highly adaptable,scalable,and capable of targeting emerging strains.Preclinical studies highlight the enhanced efficacy of mRNA TB vaccines over BCG,demonstrating their ability to reduce bacterial burdens and generate memory T-cell responses critical for long-term protection.However,challenges persist,including mRNA instability,cold-chain storage needs,and mycobacterium’s complex immune evasion strategies.Innovative solutions,such as lipid nanoparticle delivery systems and selfamplifying mRNA platforms,are being developed to address these barriers.The initiation of clinical trials,notably BioNTech’s BNT164,marks a pivotal advancement in TB vaccine development.These trials focus on safety,immuno genicity,and efficacy,particularly in regions with high TB prevalence.While logistical and financial hurdles remain,mRNA vaccines hold transformative potential to bridge critical gaps in TB prevention.Their adaptability extends to tackling co-infections like human immunodeficiency virus,further amplifying their impact on global health.By integrating mRNA vaccines into existing TB control strategies,these advancements could revolutionize prevention efforts,especially in regions where current solutions fall short.Continued innovation and investment are crucial to harnessing the full potential of mRNA vaccines,positioning them as a cornerstone in the fight against TB and its global eradication.展开更多
BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spi...BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia.In this study,we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging,general observations,and histopathological and bacteriological studies.AIM To establish a rabbit model of spinal tuberculosis and examine the effect on the model’s efficacy using different concentrations of Mycobacterium tuberculosis(M.tuberculosis)inoculum.METHODS New Zealand rabbits were randomly divided into experimental,control and blank groups.The experimental and control animals were sensitized with complete Freund′s adjuvant,a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge.The experimental group was divided into three subgroups(experimental 1,experimental 2,experimental 3)and infused with M.tuberculosis suspension at various concentrations.The control group was inoculated with saline and the blank group received no treatment.The 12-week post-operative survival rates were 100%,80%and 30%in the experimental groups inoculated with concentrations of 106,107 and 108 CFU/mL bacteria,respectively.RESULTS The survival rate of the control and blank groups was 100%.Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%,62.5%and 66.7%,and by computed tomography(CT)and 3-dimensional CT 44.4%,75%and 100%,respectively.At 12 weeks,the figures were 44.4%,75%and 100%by X-ray analysis and 44.4%,100%and 100%by CT and 3-dimensional CT,respectively.All surviving rabbits of the experimental groups had vertebral destruction.The positive bacterial culture rates were 22.2%,75%and 66.7%,respectively,in the experimental groups.After being sensitized with complete Freund's adjuvant,large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M.tuberculosis.CONCLUSION The experimental 1 had a low success rate at establishing an infection.The experimental 3 resulted in high mortality and complication rates.The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.展开更多
Among critically ill patients,severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality.Yet,it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the...Among critically ill patients,severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality.Yet,it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the disease.In addition,management of severe pulmonary and extrapulmonary tuberculosis is complicated given the high risk of drug-drug interactions,drug-disease interactions,and adverse drug reactions.To help clinicians acquire an up-to-date approach to severe tuberculosis,this paper will provide a narrative review of contemporary diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients.展开更多
Chronic obstructive pulmonary disease(COPD)and respiratory tuberculosis are important respiratory problems.Meeting together,these diseases can mutually worsen the severity of clinical manifestations and negatively aff...Chronic obstructive pulmonary disease(COPD)and respiratory tuberculosis are important respiratory problems.Meeting together,these diseases can mutually worsen the severity of clinical manifestations and negatively affect prognosis.COPD and tuberculosis share a number of common risk factors and pathogenetic mechanisms involving various immune and non-immune cells.Inflammation,hypoxia,oxidative stress,and lung tissue remodeling play an important role in the comorbid course of COPD and respiratory tuberculosis.These mechanisms are of diagnostic interest and are promising therapeutic targets.Thus,the aim of the current review is to discuss the mechanisms of the comorbid course of chronic obstructive pulmonary disease and respiratory tuberculosis.展开更多
BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-ye...BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.展开更多
Tuberculosis(TB)is still a major public health issue in developing countries,where it causes a heavy disease burden.Although current anti-TB treatment regimens demonstrate high efficacy,the hepatotoxic potential of fi...Tuberculosis(TB)is still a major public health issue in developing countries,where it causes a heavy disease burden.Although current anti-TB treatment regimens demonstrate high efficacy,the hepatotoxic potential of first-line anti-TB drugs(ATDs)-particularly isoniazid,rifampicin,and pyrazinamide-poses a considerable risk,as these agents are associated with a significant incidence of ATD-induced liver injury(AT-DILI).The clinical presentation of AT-DILI can range from asymptomatic elevations in serum transaminases,which may resolve spontaneously due to hepatic adaptation,to acute liver failure(ALF),a potentially life-threatening condition.A recent meta-analysis reported a global incidence of AT-DILI of 11.5%,with rates varying from 2%to 28%.Approximately 7%of patients with AT-DILI progress to ALF,a condition characterized by a poor survival rate with medical therapy.ATD-induced ALF(AT-ALF)is clinically indistinguishable from ALF due to other causes and disproportionately affects young female patients,typically within eight weeks of treatment initiation.Emergency liver transplantation has become an effective therapeutic option for AT-ALF,although outcomes are generally poorer compared to elective transplantation.This minireview provides a comprehensive overview of AT-ALF,covering its epidemiology,risk factors,clinical presentation,prognosis,and treatment options.展开更多
Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic a...Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic adhesiolysis is the primary treatment for IUA;however,studies specifically addressing its efficacy in tuberculosisinduced IUA remain scarce.This study aims to evaluate the therapeutic outcomes of hysteroscopic adhesiolysis for IUA caused by endometrial tuberculosis.Methods:This retrospective cohort study included patients diagnosed with tuberculosisinduced IUA who underwent hysteroscopic adhesiolysis at the Third Xiangya Hospital of Central South University between May 2014 and October 2022.Clinical data including age,medical history,adhesion severity,surgical treatment,and reproductive outcomes were analyzed.Results:Among 39 patients identified,2 were lost to follow-up.A total of 37 patients were included,with a follow-up duration ranging from 6 months to 9 years.Hypomenorrhea was reported in 24(64.9%)patients,secondary amenorrhea in 10(27.0%)patients,and normal menstruation in 3(8.1%)patients.Most patients presented with primary infertility(59.5%),and only 2(5.4%)had secondary infertility.The median American Fertility Society(AFS)score at initial assessment was 10(range,8−12);8(21.6%)patients had moderate IUA,and 29(78.4%)had severe IUA.A total of 86 surgical procedures were performed across 37 patients,with 27 patients undergoing 2 or more surgeries.Postoperatively,25(67.6%)patients achieved normalization of the uterine cavity,while 12(32.4%)still had a reduced cavity.Only 7(18.9%)patients had a grossly normal endometrium at the final surgery,all of whom had moderate adhesions at the initial procedure.Menstrual flow returned to normal in 12(32.4%)patients,while 25(67.6%)continued to experience hypomenorrhea.Of 29 patients who attempted in vitro fertilization and embryo transfer(IVF-ET),only 6(20.7%)conceived.Among these,4(13.8%)delivered at term via cesarean section;one case was complicated by postpartum hemorrhage due to uterine atony and another by placental adhesion.Conclusion:Endometrial tuberculosis can lead to severe IUA.Hysteroscopic adhesiolysis facilitates cavity restoration and improvement of menstrual conditions,but the overall reproductive outcomes remain suboptimal.展开更多
Objective:To assess aptamer-based assays for diagnosing latent tuberculosis infection(LTBI).Methods:Literature from Medline,ScienceDirect,and Scopus,covering publications from January 1,2012,to December 31,2023,was ex...Objective:To assess aptamer-based assays for diagnosing latent tuberculosis infection(LTBI).Methods:Literature from Medline,ScienceDirect,and Scopus,covering publications from January 1,2012,to December 31,2023,was examined.This review evaluates different aptamers,biomarkers,sample types,sample sizes,reference assays,and the assays'sensitivity and specificity.By using the Quality Assessment of Diagnostic Accuracy Studies 2,the risk of bias in each study was evaluated.Results:Aptamer-based assays generally showed a sensitivity of 90%(95%CI:75%-100%)and specificity of 90%(95%CI:50%-100%),where optical aptasensor showed the highest sensitivity and specificity at 100%.Serum samples were frequently used to enhance antigen detectability,improving the assay’s performance.Meanwhile,HspX was the most studied biomarker,followed by MPT64,and IFN-γ.Conclusions:Aptamer-based assays could be reliable alternatives to current LTBI detection methods,but further research is needed to validate their clinical efficacy.展开更多
BACKGROUND India has the highest tuberculosis(TB)burden in the world.Of the estimated annual 10 million TB cases,features of extra pulmonary TB are evident in up to 45%.Urogenital TB(UGTB)accounts for approximately 20...BACKGROUND India has the highest tuberculosis(TB)burden in the world.Of the estimated annual 10 million TB cases,features of extra pulmonary TB are evident in up to 45%.Urogenital TB(UGTB)accounts for approximately 20%of those cases.The lack of non-sputum based diagnostic tools continue to hinder efforts to reduce the burden of UGTB.MicroRNAs(miRNAs)play a crucial role in biological pathways and can be used as a potential biomarker for TB.We evaluated urinary extracellular vesicles(uEVs)as non-invasive source to explore miRNAs with biomarker potential for UGTB.AIM To evaluate the potential of miRNA-155-5p,miRNA-26a-5p and miRNA-29a-3p in uEVs to diagnose UGTB in adults.METHODS uEV characterization was done using nanoparticle tracking analysis and flow cytometry.Quantitative reverse transcriptase polymerase chain reaction(qRTPCR)for urinary uEV-miRNAs were carried out in samples from patients with suspected UGTB,or Urinary tract infections[UTI,disease controls(DC)]and healthy controls(HCs)(n=20/group).U6 was used to normalize the qRT-PCR data.Receivers operating characteristic curves was used to calculate the diagnostic accuracy of uEV-miRNAs to differentiate UGTB from controls(DC and HCs).RESULTS uEVs from UGTB or UTI patients had higher mean size,and also lower proportion of CD63 positive vesicles as compared to HC’s uEVs.Between UTI and UGTB,the mean size of uEVs was significantly higher in UTI cases.qRT-PCR analysis revealed a significantly lower abundance of miRNA-155-5p and miRNA-26a-5p in uEVs from UGTB relative to UTI(P value=0.004)and HC(P value=0.009)respectively n=20/group).While,miRNA-29a-3p was higher in abundance in both UGTB and HCs’uEV,relative to uEVs from UTI cases(P values=0.004 and 0.002 respectively,n=20/group).Moreover,miRNA-155-5p[area under curve(AUC)=0.88,P≤0.0001]and miRNA-29a-3p(AUC=0.76,P value=0.005)had optimal diagnostic accuracy to differentiate UGTB from DC(n=20/groups)with a likelihood ratio of 5.2 and 4.3,respectively through receivers operating characteristic curve.While,miRNA-155-5p(AUC=0.68,P value=0.05)and miRNA-26a-5p(AUC=0.78,P value=0.002)had optimal diagnostic accuracy to differentiate UGTB from HCs with a likelihood ratio of>2.CONCLUSION The differential expression of uEV-miRNAs,miRNA-155-5p and miRNA-29a-3p in UTGB and UTI cases hold promise in the specific diagnosis of UGTB.Further studies in large cohort are,however,needed to confirm the diagnostic accuracy of these uEV-miRNAs.展开更多
BACKGROUND Tuberculosis(TB)remains a global health concern despite decreasing incidence.Delayed TB diagnosis can exacerbate patient outcomes and lead to broader public health issues such as mass infections.Differentia...BACKGROUND Tuberculosis(TB)remains a global health concern despite decreasing incidence.Delayed TB diagnosis can exacerbate patient outcomes and lead to broader public health issues such as mass infections.Differentiation between TB and bacterial pneumonia is often complicated by variable clinical and radiological manifestations of TB,leading to diagnostic delays.CASE SUMMARY An 89-year-old,Japanese male patient with a history of diabetes mellitus,hypertension,and hypothyroidism presented with right-sided chest pain.Based on the elevated inflammatory response,right pleural effusion,and infiltrating shadow in the lung field,the diagnosis of right pleurisy was made and the antibiotic,ampicillin/sulbactam,was administered.The patient’s condition,inflammatory reaction,and right pleural effusion temporarily improved.However,persistent low-grade fever and malaise prompted further evaluation,revealing repeated right pleural effusion and inflammatory response.A right thoracentesis was performed;the patient was diagnosed with tuberculous pleurisy as a result of exudative effusion with lymphocyte predominance,elevated adenosine deaminase levels,and positive Mycobacterium TB polymerase chain reaction test.Anti-TB treatment,including isoniazid,rifampicin,and ethambutol was initiated,leading to significant clinical improvement.The patient successfully completed a 12-month course of TB therapy without recurrence or deterioration.CONCLUSION There are cases of TB wherein temporary improvement apparently could be shown through treatment with antimicrobial agents other than anti-TB drugs,necessitating careful evaluation in atypical cases of bacterial pneumonia.展开更多
Mycobacterium tuberculosis(Mtb)employs multiple mechanisms,such as phagocytosis and autophagy,to evade innate immune clearance and establish infection.In the present study,we identified the ESX-1 secretion-associated ...Mycobacterium tuberculosis(Mtb)employs multiple mechanisms,such as phagocytosis and autophagy,to evade innate immune clearance and establish infection.In the present study,we identified the ESX-1 secretion-associated protein EspL,which promotes Mtb survival by inhibiting phagosome maturation and autophagy initiation.EspL knockout decreased Mtb intracellular survival,while EspL overexpression increased bacterial survival by interfering with phagocytosis and autophagy.EspL interacts with ULK1 and promotes its phosphorylation at Ser^(757),leading to the inhibition of autophagy initiation.Additionally,overexpression of EspL reduced antigen presentation and T-cell responses both in vitro and in vivo.Our findings revealed that EspL interferes with autophagy and antigen presenta-tion by suppressing ULK1 activation.These insights provide a novel understanding of Mtb pathogenicity.展开更多
BACKGROUND Tuberculosis(TB)is a common infection causing huge morbidity and mortality to mankind.The analytical methods used in diagnosing TB are not sensitive in paucibacillary infections and also require trained tec...BACKGROUND Tuberculosis(TB)is a common infection causing huge morbidity and mortality to mankind.The analytical methods used in diagnosing TB are not sensitive in paucibacillary infections and also require trained technical personnel.MicroRNAs are stable in serum and other body fluids,and hold great potential in the diagnosis of TB.AIM To analyze the dysregulated microRNA profiles among patients with cavitatory and non-cavitatory pulmonary TB.METHODS The prospective study will be conducted in a tertiary care center in India.Adult patients with newly diagnosed pulmonary TB will be included.There will be two groups:Patients with sputum positive pulmonary TB with cavity and without cavity(group1),and apparently healthy individuals(group 2).The participants will undergo sputum examination,Xpert Mycobacterium TB complex/resistance to rifampin(Mtb/RIF)assay,chest X-ray,and blood investigations and serum microRNA detection.Ethics approval has been obtained.Written informed consent will be obtained.Appropriate statistical analyses will be used.RESULTS MicroRNAs will be correlated with sputum positivity,Xpert Mtb/RIF assay,radiological involvement,inflammatory markers,and course of the disease among cases and controls.CONCLUSION MicroRNAs could serve as potential diagnostic biomarkers in diagnostically challenging TB patients.展开更多
There is a bidirectional association between type II diabetes mellitus(T2DM)and pulmonary tuberculosis(PTB),with each enhancing the risk of the other,thus increasing the burden of both drug-sensitive and drug-resistan...There is a bidirectional association between type II diabetes mellitus(T2DM)and pulmonary tuberculosis(PTB),with each enhancing the risk of the other,thus increasing the burden of both drug-sensitive and drug-resistant forms of the disease.This dual burden also has a detrimental impact on patient's mental health.Although several recommendations have been made for bidirectional screening of diabetes and tuberculosis,implementation remains poor,resulting in increased morbidity and mortality among patients with this comorbidity.Mental health is often neglected,as clinical outcomes receive disproportionate focus,with limited attention to patients’social and psychological well-being.According to the World Health Organization,health is defined as a state of physical,mental,and social well-being,and not merely the absence of disease or infirmity.The aim of this mini-review is to highlight the intersection of PTB and T2DM,specifically discussing the mental health outcomes of the co-burden.展开更多
Tuberculosis(TB)remained the first leading cause of death from a single infectious agent worldwide in 2023,resulting in nearly twice as many deaths as those caused by the human immunodeficiency virus/acquired immune d...Tuberculosis(TB)remained the first leading cause of death from a single infectious agent worldwide in 2023,resulting in nearly twice as many deaths as those caused by the human immunodeficiency virus/acquired immune deficiency syndrome.An estimated 10.8 million TB cases were reported globally in 2023,with approximately 1.25 million associated deaths.In China,which ranks third in the global TB burden,there were approximately 741,000 new cases and 25,000 deaths in 2023^([1]).TB poses a significant threat to human health worldwide.展开更多
Objectives This study aimed to investigate the impact of foam macrophages(FMs) on the intracellular survival of Mycobacterium tuberculosis(MTB) and identify the molecular mechanisms influencing MTB survival.Methods An...Objectives This study aimed to investigate the impact of foam macrophages(FMs) on the intracellular survival of Mycobacterium tuberculosis(MTB) and identify the molecular mechanisms influencing MTB survival.Methods An in vitro FM model was established using oleic acid induction. Transcriptomic and metabolomic analyses were conducted to identify the key molecular pathways involved in FM-mediated MTB survival.Results Induced FMs effectively restricted MTB survival. Transcriptomic and metabolomic profiling revealed distinct changes in gene and metabolite expression in FMs during MTB infection compared with normal macrophages. Integrated analyses identified significant alterations in the cyclic adenosine monophosphate(cAMP) signaling pathway, indicating that its activation contributes to the FM-mediated restriction of MTB survival.Conclusions FMs inhibit MTB survival. The cAMP signaling pathway is a key contributor. These findings enhance the understanding of the role of FMs in tuberculosis progression, suggest potential targets for host-directed therapies, and offer new directions for developing diagnostic and therapeutic strategies against tuberculosis.展开更多
Background:C hina is a high-burden country for multidrug-r esistant tuberculosis/rifampin-resistant tuberculosis(MDR/RR-T B).Fluoroquinolones(FQs)are key drugs for the treatment of patients with MDR/RR-T B.However,res...Background:C hina is a high-burden country for multidrug-r esistant tuberculosis/rifampin-resistant tuberculosis(MDR/RR-T B).Fluoroquinolones(FQs)are key drugs for the treatment of patients with MDR/RR-T B.However,research on the resistance of FQs in Beijing is limited.Methods:W e collected clinical isolates from all patients with pulmonary TB in Beijing from January 2016 to December 2021,conducted drug-s ensitivity tests and sequencing for levofloxacin(LFX)and moxifloxacin(MFX),and collected the treatment plans and outcomes of the patients.Results:A total of 8512 clinical isolates were collected from patients with pulmonary TB,and 261 RR-T B strains were screened.The proportions of drug-s ensitive and drugresistant strains significantly differed by age group and treatment history.The rates of LFX and MFX resistance were 27.6%(72/261)and 36.4%(95/261),respectively.The detection rates of MDR-T B and pre-e xtensively drug-resistant TB(pre-X DR-T B)were 73.2%(191/261)and 36.4%(95/261),respectively,and the trends were significant(χ^(2)trend=9.995,p=0.002;χ^(2)trend=12.744,p=0.026).Among the 261 RR-T B strains,14.9%(24/261)were sensitive to LFX but resistant to MFX.Among the four patients with LFX-r esistant TB who received LFX treatment failed in three patients(Fisher's exact test,p=0.009).The common mutation sites were 94 and 90 in gyrA.A novel mutation Ala90Ser was discovered.Conclusions:F Qs resistance trends in RR-T B patients in Beijing are striking.Strains showed incomplete cross-resistance to LFX and MFX.Testing for FQs resistance and developing a reasonable treatment plan are recommended.Attention should be given to the changing trends in MDR-T B and pre-X DR-TB.展开更多
Objective To assess the independent and combined effects of air pollutants,meteorological factors,and greenspace exposure on new tuberculosis(TB)cases.Methods TB case data from Shanghai(2013–2018)were obtained from t...Objective To assess the independent and combined effects of air pollutants,meteorological factors,and greenspace exposure on new tuberculosis(TB)cases.Methods TB case data from Shanghai(2013–2018)were obtained from the Shanghai Center for Disease Control and Prevention.Environmental data on air pollutants,meteorological variables,and greenspace exposure were obtained from the National Tibetan Plateau Data Center.We employed a distributed-lag nonlinear model to assess the effects of these environmental factors on TB cases.Results Increased TB risk was linked to PM_(2.5),PM_(10),and rainfall,whereas NO_(2),SO_(2),and air pressure were associated with a reduced risk.Specifically,the strongest cumulative effects occurred at various lags:PM_(2.5)(RR=1.166,95%CI:1.026–1.325)at 0–19 weeks;PM_(10)(RR=1.167,95%CI:1.028–1.324)at 0–18 weeks;NO_(2)(RR=0.968,95%CI:0.938–0.999)at 0–1 weeks;SO_(2)(RR=0.945,95%CI:0.894–0.999)at 0–2 weeks;air pressure(RR=0.604,95%CI:0.447–0.816)at 0–8 weeks;and rainfall(RR=1.404,95%CI:1.076–1.833)at 0–22 weeks.Green space exposure did not significantly impact TB cases.Additionally,low temperatures amplified the effect of PM_(2.5)on TB.Conclusion Exposure to PM_(2.5),PM_(10),and rainfall increased the risk of TB,highlighting the need to address air pollutants for the prevention of TB in Shanghai.展开更多
BACKGROUND Pancreatic tuberculosis(PTB)is a rare disease,even in immunocompetent hosts.Abdominal tuberculosis involving the pancreatic head and peripancreatic areas may simulate pancreatic head carcinoma.CASE SUMMARY ...BACKGROUND Pancreatic tuberculosis(PTB)is a rare disease,even in immunocompetent hosts.Abdominal tuberculosis involving the pancreatic head and peripancreatic areas may simulate pancreatic head carcinoma.CASE SUMMARY We present the case of a 32-year-old man who was admitted to our hospital for intermittent epigastric pain and weight loss.A computed tomography scan and magnetic resonance imaging revealed a mass in the head of the pancreas.The lesion was initially diagnosed as pancreatic head carcinoma on abdominal imaging.Laparotomy confirmed the diagnosis of PTB and the patient received antituberculosis therapy.CONCLUSION The present case is reported to emphasize the importance of including PTB in the differential diagnosis of pancreatic lesions.展开更多
As a major global public health issue,tuberculosis is closely related to multiple socio-ecological factors in its epidemiological patterns~([1]).China,as a high-burden country for tuberculosis,exhibits regional variat...As a major global public health issue,tuberculosis is closely related to multiple socio-ecological factors in its epidemiological patterns~([1]).China,as a high-burden country for tuberculosis,exhibits regional variations in the distribution of the tuberculosis epidemic.To enhance the efficiency of prevention and control,its strategies are undergoing a transition toward regionally differentiated approaches~([2]).展开更多
文摘Detection and treatment of drug resistance in extrapulmonary tuberculosis(EPTB)is a major challenge worldwide.Drug resistance in EPTB has not been studied extensively.However,patients with drug-resistant EPTB have been reported to have poor outcomes[1].Rifampicin and isoniazid are the cornerstone drugs in the management of EPTB.Resistance in Mycobacterium(M.)tuberculosis to these drugs commonly arises due to mutations in the‘rpoB’gene and‘katG&inhA’genes,which confer resistance to rifampicin and isoniazid,respectively.Treatment outcomes are affected by the presence of these mutations.In addition,anatomical and physiological barriers impede the effective delivery of drugs to the affected extrapulmonary site[1].An analysis of the frequency of mutations in drug resistant M.tuberculosis strains causing EPTB in our region can help identify patterns of drug resistance.This,in turn,can provide inputs that may be used for modifying standard treatment regimens to make them more effective.The present study aims to identify the frequency and pattern of mutations in the‘rpoB’gene and‘katG&inhA’genes in M.tuberculosis strains isolated from EPTB samples.
文摘Tuberculosis(TB)remains a critical global health challenge,with 10.8 million new cases and over 1.25 million deaths reported annually,disproportionately affecting low-income regions.Despite its use,the Bacillus Calmette-Guérin(BCG)vaccine provides limited protection against adult pulmonary TB,necessitating novel solutions.The messenger RNA(mRNA)vaccine technology,proven effective in combating coronavirus disease 2019,offers significant promise for TB prevention.These vaccines elicit robust immune responses by encoding antigens that stimulate humoral and cell-mediated immunity,essential for combating mycobacterium TB.Unlike traditional methods,mRNA vaccines are highly adaptable,scalable,and capable of targeting emerging strains.Preclinical studies highlight the enhanced efficacy of mRNA TB vaccines over BCG,demonstrating their ability to reduce bacterial burdens and generate memory T-cell responses critical for long-term protection.However,challenges persist,including mRNA instability,cold-chain storage needs,and mycobacterium’s complex immune evasion strategies.Innovative solutions,such as lipid nanoparticle delivery systems and selfamplifying mRNA platforms,are being developed to address these barriers.The initiation of clinical trials,notably BioNTech’s BNT164,marks a pivotal advancement in TB vaccine development.These trials focus on safety,immuno genicity,and efficacy,particularly in regions with high TB prevalence.While logistical and financial hurdles remain,mRNA vaccines hold transformative potential to bridge critical gaps in TB prevention.Their adaptability extends to tackling co-infections like human immunodeficiency virus,further amplifying their impact on global health.By integrating mRNA vaccines into existing TB control strategies,these advancements could revolutionize prevention efforts,especially in regions where current solutions fall short.Continued innovation and investment are crucial to harnessing the full potential of mRNA vaccines,positioning them as a cornerstone in the fight against TB and its global eradication.
基金Supported by Lanzhou City Science and Technology Development Guiding Plan Project,No.2023-ZD-170Lanzhou Science and Technology Plan Project,No.2023-2-11High-Level Talent Training Project At the 940th Hospital of the Joint Logistics Force,No.2024-G3-5.
文摘BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia.In this study,we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging,general observations,and histopathological and bacteriological studies.AIM To establish a rabbit model of spinal tuberculosis and examine the effect on the model’s efficacy using different concentrations of Mycobacterium tuberculosis(M.tuberculosis)inoculum.METHODS New Zealand rabbits were randomly divided into experimental,control and blank groups.The experimental and control animals were sensitized with complete Freund′s adjuvant,a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge.The experimental group was divided into three subgroups(experimental 1,experimental 2,experimental 3)and infused with M.tuberculosis suspension at various concentrations.The control group was inoculated with saline and the blank group received no treatment.The 12-week post-operative survival rates were 100%,80%and 30%in the experimental groups inoculated with concentrations of 106,107 and 108 CFU/mL bacteria,respectively.RESULTS The survival rate of the control and blank groups was 100%.Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%,62.5%and 66.7%,and by computed tomography(CT)and 3-dimensional CT 44.4%,75%and 100%,respectively.At 12 weeks,the figures were 44.4%,75%and 100%by X-ray analysis and 44.4%,100%and 100%by CT and 3-dimensional CT,respectively.All surviving rabbits of the experimental groups had vertebral destruction.The positive bacterial culture rates were 22.2%,75%and 66.7%,respectively,in the experimental groups.After being sensitized with complete Freund's adjuvant,large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M.tuberculosis.CONCLUSION The experimental 1 had a low success rate at establishing an infection.The experimental 3 resulted in high mortality and complication rates.The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.
文摘Among critically ill patients,severe pulmonary and extrapulmonary tuberculosis has high morbidity and mortality.Yet,it is a diagnostic challenge given its nonspecific clinical symptoms and signs in early stages of the disease.In addition,management of severe pulmonary and extrapulmonary tuberculosis is complicated given the high risk of drug-drug interactions,drug-disease interactions,and adverse drug reactions.To help clinicians acquire an up-to-date approach to severe tuberculosis,this paper will provide a narrative review of contemporary diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients.
文摘Chronic obstructive pulmonary disease(COPD)and respiratory tuberculosis are important respiratory problems.Meeting together,these diseases can mutually worsen the severity of clinical manifestations and negatively affect prognosis.COPD and tuberculosis share a number of common risk factors and pathogenetic mechanisms involving various immune and non-immune cells.Inflammation,hypoxia,oxidative stress,and lung tissue remodeling play an important role in the comorbid course of COPD and respiratory tuberculosis.These mechanisms are of diagnostic interest and are promising therapeutic targets.Thus,the aim of the current review is to discuss the mechanisms of the comorbid course of chronic obstructive pulmonary disease and respiratory tuberculosis.
文摘BACKGROUND Pancreatic tuberculosis(TB)is a rare clinical condition that is frequently misdia-gnosed.A definitive diagnosis is often established through surgical biopsy.CASE SUMMARY We report a previously healthy 21-year-old male who presented with epigastric pain and fever.Initially diagnosed with a pancreatic abscess and duodenal bulb perforation,the patient declined surgical intervention and was subsequently re-ferred to our hospital.Abdominal computed tomography and endoscopy revea-led a duodenal bulb perforation,esophageal and duodenal ulcers,and a mass in the pancreatic head.Endoscopic ultrasound with fine-needle aspiration identified a hypoechoic mass suggestive of TB.Cytological and histopathological analysis confirmed the diagnosis.The patient was diagnosed with primary pancreatic TB and started on anti-TB therapy.At the 1-year follow-up,the pancreatic mass had markedly regressed,and the patient had fully recovered with complete symptom resolution.CONCLUSION Pancreatic TB should be included in differential diagnosis;prompt endoscopic ul-trasound-fine-needle aspiration and therapy enable recovery.
文摘Tuberculosis(TB)is still a major public health issue in developing countries,where it causes a heavy disease burden.Although current anti-TB treatment regimens demonstrate high efficacy,the hepatotoxic potential of first-line anti-TB drugs(ATDs)-particularly isoniazid,rifampicin,and pyrazinamide-poses a considerable risk,as these agents are associated with a significant incidence of ATD-induced liver injury(AT-DILI).The clinical presentation of AT-DILI can range from asymptomatic elevations in serum transaminases,which may resolve spontaneously due to hepatic adaptation,to acute liver failure(ALF),a potentially life-threatening condition.A recent meta-analysis reported a global incidence of AT-DILI of 11.5%,with rates varying from 2%to 28%.Approximately 7%of patients with AT-DILI progress to ALF,a condition characterized by a poor survival rate with medical therapy.ATD-induced ALF(AT-ALF)is clinically indistinguishable from ALF due to other causes and disproportionately affects young female patients,typically within eight weeks of treatment initiation.Emergency liver transplantation has become an effective therapeutic option for AT-ALF,although outcomes are generally poorer compared to elective transplantation.This minireview provides a comprehensive overview of AT-ALF,covering its epidemiology,risk factors,clinical presentation,prognosis,and treatment options.
基金supported by the Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hosipital of Central South University,China(YX202112).
文摘Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic adhesiolysis is the primary treatment for IUA;however,studies specifically addressing its efficacy in tuberculosisinduced IUA remain scarce.This study aims to evaluate the therapeutic outcomes of hysteroscopic adhesiolysis for IUA caused by endometrial tuberculosis.Methods:This retrospective cohort study included patients diagnosed with tuberculosisinduced IUA who underwent hysteroscopic adhesiolysis at the Third Xiangya Hospital of Central South University between May 2014 and October 2022.Clinical data including age,medical history,adhesion severity,surgical treatment,and reproductive outcomes were analyzed.Results:Among 39 patients identified,2 were lost to follow-up.A total of 37 patients were included,with a follow-up duration ranging from 6 months to 9 years.Hypomenorrhea was reported in 24(64.9%)patients,secondary amenorrhea in 10(27.0%)patients,and normal menstruation in 3(8.1%)patients.Most patients presented with primary infertility(59.5%),and only 2(5.4%)had secondary infertility.The median American Fertility Society(AFS)score at initial assessment was 10(range,8−12);8(21.6%)patients had moderate IUA,and 29(78.4%)had severe IUA.A total of 86 surgical procedures were performed across 37 patients,with 27 patients undergoing 2 or more surgeries.Postoperatively,25(67.6%)patients achieved normalization of the uterine cavity,while 12(32.4%)still had a reduced cavity.Only 7(18.9%)patients had a grossly normal endometrium at the final surgery,all of whom had moderate adhesions at the initial procedure.Menstrual flow returned to normal in 12(32.4%)patients,while 25(67.6%)continued to experience hypomenorrhea.Of 29 patients who attempted in vitro fertilization and embryo transfer(IVF-ET),only 6(20.7%)conceived.Among these,4(13.8%)delivered at term via cesarean section;one case was complicated by postpartum hemorrhage due to uterine atony and another by placental adhesion.Conclusion:Endometrial tuberculosis can lead to severe IUA.Hysteroscopic adhesiolysis facilitates cavity restoration and improvement of menstrual conditions,but the overall reproductive outcomes remain suboptimal.
基金supported by Higher Institution Centre of Excellence(HICoE)Grant(A305-KR-AKH002-0000000278-K134)from the Ministry of Higher Education,Malaysia.
文摘Objective:To assess aptamer-based assays for diagnosing latent tuberculosis infection(LTBI).Methods:Literature from Medline,ScienceDirect,and Scopus,covering publications from January 1,2012,to December 31,2023,was examined.This review evaluates different aptamers,biomarkers,sample types,sample sizes,reference assays,and the assays'sensitivity and specificity.By using the Quality Assessment of Diagnostic Accuracy Studies 2,the risk of bias in each study was evaluated.Results:Aptamer-based assays generally showed a sensitivity of 90%(95%CI:75%-100%)and specificity of 90%(95%CI:50%-100%),where optical aptasensor showed the highest sensitivity and specificity at 100%.Serum samples were frequently used to enhance antigen detectability,improving the assay’s performance.Meanwhile,HspX was the most studied biomarker,followed by MPT64,and IFN-γ.Conclusions:Aptamer-based assays could be reliable alternatives to current LTBI detection methods,but further research is needed to validate their clinical efficacy.
基金Supported by the Indian Council of Medical Research,No.Coord/7(1)/CARE-KD/18-NCD-II.
文摘BACKGROUND India has the highest tuberculosis(TB)burden in the world.Of the estimated annual 10 million TB cases,features of extra pulmonary TB are evident in up to 45%.Urogenital TB(UGTB)accounts for approximately 20%of those cases.The lack of non-sputum based diagnostic tools continue to hinder efforts to reduce the burden of UGTB.MicroRNAs(miRNAs)play a crucial role in biological pathways and can be used as a potential biomarker for TB.We evaluated urinary extracellular vesicles(uEVs)as non-invasive source to explore miRNAs with biomarker potential for UGTB.AIM To evaluate the potential of miRNA-155-5p,miRNA-26a-5p and miRNA-29a-3p in uEVs to diagnose UGTB in adults.METHODS uEV characterization was done using nanoparticle tracking analysis and flow cytometry.Quantitative reverse transcriptase polymerase chain reaction(qRTPCR)for urinary uEV-miRNAs were carried out in samples from patients with suspected UGTB,or Urinary tract infections[UTI,disease controls(DC)]and healthy controls(HCs)(n=20/group).U6 was used to normalize the qRT-PCR data.Receivers operating characteristic curves was used to calculate the diagnostic accuracy of uEV-miRNAs to differentiate UGTB from controls(DC and HCs).RESULTS uEVs from UGTB or UTI patients had higher mean size,and also lower proportion of CD63 positive vesicles as compared to HC’s uEVs.Between UTI and UGTB,the mean size of uEVs was significantly higher in UTI cases.qRT-PCR analysis revealed a significantly lower abundance of miRNA-155-5p and miRNA-26a-5p in uEVs from UGTB relative to UTI(P value=0.004)and HC(P value=0.009)respectively n=20/group).While,miRNA-29a-3p was higher in abundance in both UGTB and HCs’uEV,relative to uEVs from UTI cases(P values=0.004 and 0.002 respectively,n=20/group).Moreover,miRNA-155-5p[area under curve(AUC)=0.88,P≤0.0001]and miRNA-29a-3p(AUC=0.76,P value=0.005)had optimal diagnostic accuracy to differentiate UGTB from DC(n=20/groups)with a likelihood ratio of 5.2 and 4.3,respectively through receivers operating characteristic curve.While,miRNA-155-5p(AUC=0.68,P value=0.05)and miRNA-26a-5p(AUC=0.78,P value=0.002)had optimal diagnostic accuracy to differentiate UGTB from HCs with a likelihood ratio of>2.CONCLUSION The differential expression of uEV-miRNAs,miRNA-155-5p and miRNA-29a-3p in UTGB and UTI cases hold promise in the specific diagnosis of UGTB.Further studies in large cohort are,however,needed to confirm the diagnostic accuracy of these uEV-miRNAs.
文摘BACKGROUND Tuberculosis(TB)remains a global health concern despite decreasing incidence.Delayed TB diagnosis can exacerbate patient outcomes and lead to broader public health issues such as mass infections.Differentiation between TB and bacterial pneumonia is often complicated by variable clinical and radiological manifestations of TB,leading to diagnostic delays.CASE SUMMARY An 89-year-old,Japanese male patient with a history of diabetes mellitus,hypertension,and hypothyroidism presented with right-sided chest pain.Based on the elevated inflammatory response,right pleural effusion,and infiltrating shadow in the lung field,the diagnosis of right pleurisy was made and the antibiotic,ampicillin/sulbactam,was administered.The patient’s condition,inflammatory reaction,and right pleural effusion temporarily improved.However,persistent low-grade fever and malaise prompted further evaluation,revealing repeated right pleural effusion and inflammatory response.A right thoracentesis was performed;the patient was diagnosed with tuberculous pleurisy as a result of exudative effusion with lymphocyte predominance,elevated adenosine deaminase levels,and positive Mycobacterium TB polymerase chain reaction test.Anti-TB treatment,including isoniazid,rifampicin,and ethambutol was initiated,leading to significant clinical improvement.The patient successfully completed a 12-month course of TB therapy without recurrence or deterioration.CONCLUSION There are cases of TB wherein temporary improvement apparently could be shown through treatment with antimicrobial agents other than anti-TB drugs,necessitating careful evaluation in atypical cases of bacterial pneumonia.
基金supported by the National Natural Science Foundation of China under grant number U21A20259the National Key Research and Development Program of China under grant number 2021YFD1800401.
文摘Mycobacterium tuberculosis(Mtb)employs multiple mechanisms,such as phagocytosis and autophagy,to evade innate immune clearance and establish infection.In the present study,we identified the ESX-1 secretion-associated protein EspL,which promotes Mtb survival by inhibiting phagosome maturation and autophagy initiation.EspL knockout decreased Mtb intracellular survival,while EspL overexpression increased bacterial survival by interfering with phagocytosis and autophagy.EspL interacts with ULK1 and promotes its phosphorylation at Ser^(757),leading to the inhibition of autophagy initiation.Additionally,overexpression of EspL reduced antigen presentation and T-cell responses both in vitro and in vivo.Our findings revealed that EspL interferes with autophagy and antigen presenta-tion by suppressing ULK1 activation.These insights provide a novel understanding of Mtb pathogenicity.
文摘BACKGROUND Tuberculosis(TB)is a common infection causing huge morbidity and mortality to mankind.The analytical methods used in diagnosing TB are not sensitive in paucibacillary infections and also require trained technical personnel.MicroRNAs are stable in serum and other body fluids,and hold great potential in the diagnosis of TB.AIM To analyze the dysregulated microRNA profiles among patients with cavitatory and non-cavitatory pulmonary TB.METHODS The prospective study will be conducted in a tertiary care center in India.Adult patients with newly diagnosed pulmonary TB will be included.There will be two groups:Patients with sputum positive pulmonary TB with cavity and without cavity(group1),and apparently healthy individuals(group 2).The participants will undergo sputum examination,Xpert Mycobacterium TB complex/resistance to rifampin(Mtb/RIF)assay,chest X-ray,and blood investigations and serum microRNA detection.Ethics approval has been obtained.Written informed consent will be obtained.Appropriate statistical analyses will be used.RESULTS MicroRNAs will be correlated with sputum positivity,Xpert Mtb/RIF assay,radiological involvement,inflammatory markers,and course of the disease among cases and controls.CONCLUSION MicroRNAs could serve as potential diagnostic biomarkers in diagnostically challenging TB patients.
文摘There is a bidirectional association between type II diabetes mellitus(T2DM)and pulmonary tuberculosis(PTB),with each enhancing the risk of the other,thus increasing the burden of both drug-sensitive and drug-resistant forms of the disease.This dual burden also has a detrimental impact on patient's mental health.Although several recommendations have been made for bidirectional screening of diabetes and tuberculosis,implementation remains poor,resulting in increased morbidity and mortality among patients with this comorbidity.Mental health is often neglected,as clinical outcomes receive disproportionate focus,with limited attention to patients’social and psychological well-being.According to the World Health Organization,health is defined as a state of physical,mental,and social well-being,and not merely the absence of disease or infirmity.The aim of this mini-review is to highlight the intersection of PTB and T2DM,specifically discussing the mental health outcomes of the co-burden.
文摘Tuberculosis(TB)remained the first leading cause of death from a single infectious agent worldwide in 2023,resulting in nearly twice as many deaths as those caused by the human immunodeficiency virus/acquired immune deficiency syndrome.An estimated 10.8 million TB cases were reported globally in 2023,with approximately 1.25 million associated deaths.In China,which ranks third in the global TB burden,there were approximately 741,000 new cases and 25,000 deaths in 2023^([1]).TB poses a significant threat to human health worldwide.
基金supported by the Beijing Natural Science Foundation (grant number: 7232060)National Key Research and Development Program of China (grant number: 2023YFC2307301)Top Level Public Health Technical Personnel Training Plan (grant number: LJRC-03-09)。
文摘Objectives This study aimed to investigate the impact of foam macrophages(FMs) on the intracellular survival of Mycobacterium tuberculosis(MTB) and identify the molecular mechanisms influencing MTB survival.Methods An in vitro FM model was established using oleic acid induction. Transcriptomic and metabolomic analyses were conducted to identify the key molecular pathways involved in FM-mediated MTB survival.Results Induced FMs effectively restricted MTB survival. Transcriptomic and metabolomic profiling revealed distinct changes in gene and metabolite expression in FMs during MTB infection compared with normal macrophages. Integrated analyses identified significant alterations in the cyclic adenosine monophosphate(cAMP) signaling pathway, indicating that its activation contributes to the FM-mediated restriction of MTB survival.Conclusions FMs inhibit MTB survival. The cAMP signaling pathway is a key contributor. These findings enhance the understanding of the role of FMs in tuberculosis progression, suggest potential targets for host-directed therapies, and offer new directions for developing diagnostic and therapeutic strategies against tuberculosis.
基金The Research and Cultivation Spectial Project of Beijing Center for Disease Prevention and Control,Grant/Award Number:2023-KYJH-03。
文摘Background:C hina is a high-burden country for multidrug-r esistant tuberculosis/rifampin-resistant tuberculosis(MDR/RR-T B).Fluoroquinolones(FQs)are key drugs for the treatment of patients with MDR/RR-T B.However,research on the resistance of FQs in Beijing is limited.Methods:W e collected clinical isolates from all patients with pulmonary TB in Beijing from January 2016 to December 2021,conducted drug-s ensitivity tests and sequencing for levofloxacin(LFX)and moxifloxacin(MFX),and collected the treatment plans and outcomes of the patients.Results:A total of 8512 clinical isolates were collected from patients with pulmonary TB,and 261 RR-T B strains were screened.The proportions of drug-s ensitive and drugresistant strains significantly differed by age group and treatment history.The rates of LFX and MFX resistance were 27.6%(72/261)and 36.4%(95/261),respectively.The detection rates of MDR-T B and pre-e xtensively drug-resistant TB(pre-X DR-T B)were 73.2%(191/261)and 36.4%(95/261),respectively,and the trends were significant(χ^(2)trend=9.995,p=0.002;χ^(2)trend=12.744,p=0.026).Among the 261 RR-T B strains,14.9%(24/261)were sensitive to LFX but resistant to MFX.Among the four patients with LFX-r esistant TB who received LFX treatment failed in three patients(Fisher's exact test,p=0.009).The common mutation sites were 94 and 90 in gyrA.A novel mutation Ala90Ser was discovered.Conclusions:F Qs resistance trends in RR-T B patients in Beijing are striking.Strains showed incomplete cross-resistance to LFX and MFX.Testing for FQs resistance and developing a reasonable treatment plan are recommended.Attention should be given to the changing trends in MDR-T B and pre-X DR-TB.
基金supported by the National Key Research and Development Program of China[2023YFC2307305]Shenzhen Medical Research Fund[B2303003]+3 种基金the Zhujiang Innovation and Entrepreneurship Talents Program[2021ZT09Y544]the Shenzhen Science and Technology Program[ZDSYS20230626091203007]Shanghai CDC(Shanghai three-year(2023–2025)action plan to strengthen the public health system[GWVI–11.1–05])Top Young Talents in Shanghai。
文摘Objective To assess the independent and combined effects of air pollutants,meteorological factors,and greenspace exposure on new tuberculosis(TB)cases.Methods TB case data from Shanghai(2013–2018)were obtained from the Shanghai Center for Disease Control and Prevention.Environmental data on air pollutants,meteorological variables,and greenspace exposure were obtained from the National Tibetan Plateau Data Center.We employed a distributed-lag nonlinear model to assess the effects of these environmental factors on TB cases.Results Increased TB risk was linked to PM_(2.5),PM_(10),and rainfall,whereas NO_(2),SO_(2),and air pressure were associated with a reduced risk.Specifically,the strongest cumulative effects occurred at various lags:PM_(2.5)(RR=1.166,95%CI:1.026–1.325)at 0–19 weeks;PM_(10)(RR=1.167,95%CI:1.028–1.324)at 0–18 weeks;NO_(2)(RR=0.968,95%CI:0.938–0.999)at 0–1 weeks;SO_(2)(RR=0.945,95%CI:0.894–0.999)at 0–2 weeks;air pressure(RR=0.604,95%CI:0.447–0.816)at 0–8 weeks;and rainfall(RR=1.404,95%CI:1.076–1.833)at 0–22 weeks.Green space exposure did not significantly impact TB cases.Additionally,low temperatures amplified the effect of PM_(2.5)on TB.Conclusion Exposure to PM_(2.5),PM_(10),and rainfall increased the risk of TB,highlighting the need to address air pollutants for the prevention of TB in Shanghai.
文摘BACKGROUND Pancreatic tuberculosis(PTB)is a rare disease,even in immunocompetent hosts.Abdominal tuberculosis involving the pancreatic head and peripancreatic areas may simulate pancreatic head carcinoma.CASE SUMMARY We present the case of a 32-year-old man who was admitted to our hospital for intermittent epigastric pain and weight loss.A computed tomography scan and magnetic resonance imaging revealed a mass in the head of the pancreas.The lesion was initially diagnosed as pancreatic head carcinoma on abdominal imaging.Laparotomy confirmed the diagnosis of PTB and the patient received antituberculosis therapy.CONCLUSION The present case is reported to emphasize the importance of including PTB in the differential diagnosis of pancreatic lesions.
文摘As a major global public health issue,tuberculosis is closely related to multiple socio-ecological factors in its epidemiological patterns~([1]).China,as a high-burden country for tuberculosis,exhibits regional variations in the distribution of the tuberculosis epidemic.To enhance the efficiency of prevention and control,its strategies are undergoing a transition toward regionally differentiated approaches~([2]).
