Current Issue

2020 Vol.5 No.1 Published:20 January 2020

Forum of Specialist

Research progress in molecular epidemiology of hepatitis B virus Yi Yongxiang 2020, 5 (1):  1-7.  Abstract ( 317)    PDF (850KB) ( 1196 )    The molecular epidemiology of hepatitis B virus (HBV) has been a hot issue in the basic and clinical research of HBV in recent years. This article summarizes the national and international epidemic characteristics of HBV infection in the past two decades, analyzes the regional distribution characteristics of HBV genotypes/subtypes, elaborates the clinical significance of HBV genotypes, and analyzes the effect of HBV genotypes on the antiviral response. These HBV molecular epidemiological studies will help the development of anti-HBV drugs with high drug resistance barriers, and support the precise treatment of various liver-related diseases induced by HBV infection.

Original Articles

Image analysis of multiple organ invasion in acquired immunodeficiency syndrome patients with Kaposi's sarcoma Lu Yibo, Shi Yuxin, Liu Jinxin, Zhang Qianqian, Xie Ruming, Lu Zhiyan, Yang Yuxin, Zhang Na, Zheng Guangping, Ye Wen, Chen Budong, Wu Fengyao, Li Hongjun, Lu Puxuan 2020, 5 (1):  8-15.  Abstract ( 519)    PDF (4129KB) ( 1048 )    Objective To analyze the clinical imaging manifestations of multiple organ tissue invasion of AIDS with Kaposi's sarcoma, to improve the understanding of AIDS with kaposi's sarcoma, and provide the basis for clinical diagnosis and treatments. Methods Relevant datas of AIDS complicated with Kaposi's sarcoma diagnosed in several infectious hospitals in China were collected. According to the inclusion and exclusion criteria, clinical manifestations, imaging and pathological data of 48 patients meeting the requirements were sorted and analyzed. Results In 48 patients with AIDS with Kaposi's sarcoma, CD4+ T cell count was lower than 100 /UL in 37 patients (77.1%). 38 patients suffered from lung invasion, and 30 patients (30/38,78.9%) presented nodular shadows on the images. CT transversely located pulmonary window and mediastinal window, as well as coronal pseudocolor reconstruction, showed nodules with different lung sizes and vascular distribution. which were characterized by nodules of both lungs widely connected with pulmonary vessels, or flame-like/star-like, fruit hanging signs. Kaposi's sarcoma of the liver showed nodules and intrahepatic bile duct dilatation in 7 cases. 3 patients with AIDS complicated with Kaposi's sarcoma suffered from esophageal, gastric and intestinal invasion. 1 case with thyroid invasion showed low-density nodules. 1 case of rib invasion and 1 case of maxillary invasion were lytic destruction and surrounding soft tissue nodules. Two or more organs and organizers were involved in 44 cases. Conclusion The main imaging manifestations of multiple organs of AIDS with Kaposi's sarcoma are pleomorphic and vascular nodules. AIDS complicated with kaposi's sarcoma is accompanied by invasion of lung, liver, digestive tract, thyroid, rib and maxilla, and their imaging manifestations are mainly irregular nodules closely related to blood vessels.

Clinical characteristics and treatment efficacy of sever infection caused by new bunyaviridae Xiao Lingyan, Shi Dongyang, Liu Yongfu, Zheng Yishan 2020, 5 (1):  16-19.  Abstract ( 416)    PDF (854KB) ( 1309 )    Objective To summarize the clinical characteristics, prognosis and related factors affecting mortality of severe SFTS patients caused by new bunyaviridae. Methods Clinical data of 23 SFTS patients admitted to the Department of Critical Care Medicine of our hospital from August 2014 to September 2019 were collected, including epidemiological data, symptoms, signs, and the results of auxiliary examinations. According to the outcome of patients, patients were divided into two groups: survival group and death group. The differences of epidemiological data, symptoms, signs, and laboratory test indexes between the two groups were compared. Results All patients had fever, 23 cases had poor appetite, 14 cases had nausea and vomiting, 12 cases had cough and sputum, 16 cases had diarrhea and 12 cases had hemorrhage. There were 14 cases of nervous system changes, 14 cases had different degrees of consciousness disorder and bulbar conjunctival edema, 4 cases had blurred speech, 3 cases had convulsions of whole body or part of limbs, and 2 cases had positive pathological features. Eight patients died and 15 patients were discharged from hospital or transferred in the general ward for treatment. Comparing the clinical data and laboratory examinations of patients in death group and survival group, it was found that the proportion of neurological symptoms in patients that died was significantly higher than that in patients that survived (P<0.05). The viral load of the dead patients was higher and the average BNP was higher than that of the survived patients (P<0.05). The average age of the dead patients was older than that of the improved patients (P<0.05). Conclusion The mortality rate of severe SFTS patients is high. Age, neurological symptoms, poor cardiac function and poor coagulation function are important prognostic indicators. Viral load can effectively monitor the severity of the disease and predict the prognosis.

Clinical significance of systemic inflammatory response syndrome in the in-hospital outcome of hepatitis B cirrhotic patients with ascites Ji Tingting, Ye Wei, Zhao Wei 2020, 5 (1):  20-24.  Abstract ( 285)    PDF (851KB) ( 869 )    Objective To investigate the incidence of SIRS in HBV-related cirrhotic patients with ascites and determine its relationship with in-hospital outcome. Methods A study was conducted to explore the incidence of SIRS in HBV-related cirrhotic patients with ascites admitted to the Second Hospital of Nanjing from January 2013 to January 2018 and its relationship with clinical index, death and portal hypertension-related complications (including esophagogastric varices bleeding, hepatic encephalopathy and hepatorenal syndrome) during hospitalization, to further analyze the predictors of death and portal hypertension-related complications in these patients. Results There were 461 HBV-related cirrhotic patients with ascites, of which 185 had SIRS, with an incidence rate of 40.1%. We found significant correlation between SIRS and high incidence of jaundice, bacterial infection on admission, serum bilirubin, INR, Child-Pugh score, MELD score, the duration of hospital stay and low hemoglobin concentration, platelet concentration, and sodium concentration (all P<0.05). During in-hospital follow-up, 22 patients died (5.8%), 8 developed portal hypertension-related bleeding (1.7%), 4 developed hepatorenal syndrome type-1 (0.9%), and 20 developed encephalopathy (4.3%). SIRS was demonstrated to be related both to death (P<0.001) and portal hypertension-related complications(P<0.001). MELD score was the predictor of death and portal hypertension-related complications (P<0.001), while SIRS and hemoglobin were the predictors of portal hypertension related-complications (P<0.05). Conclusion SIRS is common in HBV-related cirrhotic patients with ascites, further aggravating liver function, which leads to higher incidence of in-hospital mortality and portal hypertension-related complications. The presence of SIRS can predict portal hypertension-related complications.

Strategy analysis of eliminate mother-to-child hepatitis B virus transmission Yang Lixin, Bai Shufen, He Qinyuan, Ma Changlan 2020, 5 (1):  25-27.  Abstract ( 641)    PDF (830KB) ( 898 )    Objective To elaborate on the feasibility strategy for achieving "zero mother-to-child transmission (MTCT) of HBV". Methods This retrospective study was performed in the Second Affiliated Hospital of Southeast University from January 2005 to December 2015 to evaluate the effects of the strategy of eliminating mother-to-child HBV transmission and to summarize the high-risk factors of mother-to-child transmission. Result No cases of mother-to-child HBV transmission were found if hepatitis B surface antigen (HBsAg) or hepatitis B e antigen (HBeAg) positive mothers with HBV DNA, have HBV DNA was less than 1.0×106copies/ml. If mothers with HBV DNA levels above 1.0×108copies/ml managed with oral use of telbivudine or tenofovir to implement antiviral therapy from 28 weeks of gestation, there are also no cases of mother-to-child HBV transmission were found. HBV mother-to-child transmission occurred only in HBV DNA>1.0×106copies/ml and case of not implementing antiviral therapy during pregnancy. After a birth dose of hepatitis B immunoglobulin (HBIG), in combination with hepatitis B vaccine (HepB), was used for infants born to HBV infected mothers and check the hepatitis B surface antibody (HBsAb) for infants at 2 months, 7 months and 12 months, a replenish of HepB was given to strengthen the vaccine if infants with HBsAb titer was less than 100. Conclusion HBV DNA load is a key predictor of mother-to-child HBV transmission. Antiviral treatment of nucleoside analogs in pregnant women with high HBV DNA load can be effective. The combination of immunization and enhanced follow-up for infants with a low response to HepB, and strengthen vaccination if necessary to block mother-to-child transmission, can achieve “zero mother-to-child HBV transmission”.

Analysis of the cost of isolation treatment and the infection of sputum bacteria in 56 patients with smear positive pulmonary tuberculosis Zhang Xiaoqi, Liu Jingyuan, Li Minlu, Qu Zhijun, Tan Weiguo 2020, 5 (1):  28-31.  Abstract ( 307)    PDF (835KB) ( 1100 )    Objective To analyze the cost of two weeks' isolation treatment and the change of sputum bacterial infectivity in smear positive pulmonary tuberculosis patients, and to evaluate the mode of isolation treatment and the feasibility of reducing infectivity. Methods From July 2018 to June 2019, 56 patients with smear positive tuberculosis diagnosed by Shenzhen Longgang District chronic disease prevention and control hospital and taking part in isolation treatment in hospital were collected, and the change data of hospitalization cost, sputum smear and sputum bacteria culture were analyzed. Results the average hospitalization days of 56 patients were (15.6 ± 1.5) days, 96.42% (54/56) patients were hospitalized for more than 2 weeks, the average hospitalization cost was 9805 yuan, the negative conversion rate of sputum smear was 48.21% (27/56), the negative conversion rate of sputum culture was 44.64% (25/56), and more than half of the patients were still smear positive and sputum culture positive. Conclusion the cost of isolated hospitalization is heavy, and the measures of isolated hospitalization can only be carried out on the premise of multi-channel financing to solve the cost of isolated hospitalization. Two weeks of isolated hospitalization can reduce the risk exposure of smear positive tuberculosis patients to the surrounding population, but more than half of the patients are still infectious. It is the most appropriate time and exploration for isolated hospitalization Other more economic and feasible ways such as community home isolation still need further study.

Analysis of clinical characteristics of 12 cases of patients with tetanus Tong Xuecheng, Wang Huiwen, Xu Tianmin 2020, 5 (1):  32-34.  Abstract ( 293)    PDF (850KB) ( 1147 )    Objective To analyze the clinical data of 12 cases of tetanus, summarize the experience of treatment of severe tetanus in order to reduce the mortality of tetanus. Methods A retrospective study was conducted to analyze the clinical data of 12 tetanus patients admitted by the department of infectious diseases, general surgery and intensive care unit of the Third People's Hospital of Changzhou from January 2010 to May 2019. Results Among the twelve patients, 8 were male and 4 were female, and the mean age was （57.4±14.8）years. The average incubation period is 3~60 days. The occupational composition is dominated by farmers and workers(8 cases). There were 8 cases (66.7%) with a clear history of trauma. Clinically, the most frequent symptoms observed were fever, trismus, low back pain, limb spasms, and difficulty in breathing. After admission, 9 cases of severe cases were treated with wound treatment, toxin neutralization, anti-infection, spasticity control, respiratory support and nutritional support, among which 10 cases were cured and 2 cases died. Conclusion sTetanus of adult is prone to severe disease,so early diagnosis, comprehensive treatment can reduce disease and mortality.

Comparison of the preventive effect of different antibiotics on infections in patients with myocardial infarction after interventional therapy Sheng Yanhua, Wu Jiafeng, Chen Peifen, Wu Qiang 2020, 5 (1):  35-37.  Abstract ( 253)    PDF (828KB) ( 817 )    Objective To explore the preventive effect of different application methods of antibiotics on infection after interventional therapy in patients with myocardial infarction after interventional therapy. Methods 200 patients with acute myocardial infarction who underwent interventional therapy in our hospital were divided into group A, group B, group C and group D according to the application method of antibiotics. Group A (50 cases) used antibiotics preoperatively and postoperatively, group B (50 cases) used antibiotics before operation, group C (50 cases) did not use antibiotics before operation and antibiotics were used after operation, and group D (50 cases) did not use antibiotics before and after interventional therapy. The incidence of infection after interventional therapy was compared among the four groups, and hospital stay were recorded. Results The incidence of infection was 4%, 6%, 6% and 18% in group A, group B, group C and group D after interventional therapy. There was no significant difference in the incidence of infection between group A, group B, and group C. The incidence of infection in group A, group B and group C was significantly lower than that in group D (P<0.05). The average hospitalization time of group A, group B, group C and group D was (8.7+1.2) d, (8.5+1.4) d, (8.4+1.1) D and (14.3+1.2) D. The average hospital length of stay of group A, group B and group C was significantly shorter than that of group D. The difference between groups was statistically significant (P<0.05). Conclusion The use of antibiotics before and after interventional surgery can effectively prevent post-operative infection of acute myocardial infarction, and should be reasonably applied in clinic.

Review

Eradication of Helicobacter pylori, starting with rational use of antibiotics Ren Xiaoying, Li Xuehong, Zhang Shuzhen, Wang Xiangyu, Sylvia Young, Barry Marshall, Alfred Chin Yen Tay 2020, 5 (1):  38-42.  Abstract ( 674)    PDF (861KB) ( 1682 )    Antibiotic resistance is the primary cause of treatment failure on Helicobacter pylori infection. Due to a large number of clinicians involved in the treatment of Helicobacter pylori infection in China, the irregular treatment, and the overuse of antibiotics, the resistance rate of Helicobacter pylori to various antibiotics has gradually increased, leading to the decline of successful treatment of Helicobacter pylori infection. In order to improve the eradication rate of Helicobacter pylori and combat antibiotic resistance, this review summarizes the pharmacological mechanism of seven antibiotics which are currently used for Helicobacter pylori treatment. In addition, this review also evaluates the antibiotic resistance genes associated with each of the recommended drugs to help clinicians gain a deeper understanding of the drug choices. Lastly, in regions where antibiotic resistance is common, we encourage clinical doctors to provide antibiotic susceptibility guided treatment to improve treatment success rate, reduce the emergence of resistant strains, shorten the treatment process, avoid the waste of medical resources, improve the Helicobacter pylori eradication rate, reduce the recurrence of peptic ulcer, delay the process of MALT lymphoma, prevent gastric cancer, and benefit the patients.

Epidemiology and clinical study of plague Xie Ruming, Guan Chunshuang, Chen Budong 2020, 5 (1):  43-46.  Abstract ( 514)    PDF (1996KB) ( 1123 )    Plague has been identified as a Class A infectious disease by "infectious diseases of the people's Republic of China". There have been three plague epidemics in the world, which caused great disasters. In 2000, plague was listed as a resurgent infectious disease by the World Health Organization. This article will systematically introduce the epidemiology, pathogenesis, laboratory examination, image examination, diagnosis and differential diagnosis of plague. And the review especially analyzes the epidemiological characteristics of plague, understand the pathogenesis and clinical manifestations, laboratory examination, analysis of imaging manifestations and changes.Early diagnosis, early report, early treatment and early isolation can help patients get effective treatment and avoid the spread of infection.

2019 WHO Tuberculosis Report: key data analysis for global and China Luo Yiting, Weng Rongxing, Zhou Fang, Yu Weiye, Lu Puxuan 2020, 5 (1):  47-50.  Abstract ( 293)    PDF (937KB) ( 1199 )    Tuberculosis is an infectious disease and is one of the top ten causes of death worldwide. Globally, 10 million people worldwide will be living with TB in 2018, and the majority of people developing TB (about 90 percent) are adults, with a 2∶1 ratio of men and women. In 2018, 1.2 million people without HIV died from TB, and 251,000 people with HIV died from TB.TB research and development is critical to achieving the global TB targets set out in the Sustainable Development Goals (SDGs) and the End TB Strategy. By 2025, major technological breakthroughs are needed to significantly accelerate the rate of decline in TB incidence, to achieve an average annual decline of 17 percent between 2025 and 2035.

Progress of study on acinetobacter classification Zhai Panpan, Wu Yuqian, Lu Jian 2020, 5 (1):  51-55.  Abstract ( 645)    PDF (842KB) ( 1874 )    Acinetobacter is a common bacterium that causes nosocomial infection at present, and the drug resistance rate is very high. Since the isolation and identification of Acinetobacter in 1911, the classification and naming of Acinetobacter species have been constantly updated.Early species identification based on morphological and biochemical phenotypic characteristics of acinetobacter was carried out, but the identification accuracy was not high, and the species were often wrongly identified. With the development of molecular biology technology, Acinetobacter species can be accurately identified and distinguished by whole genome sequencing technology, which provides a strong support for the in-depth study of the virulence and pathogenicity differences of Acinetobacter. This paper reviews the classification history and research status of Acinetobacter.

Clinical and imaging features of acquired immunodeficiency syndrome associated with cryptococcal meningitis Yuan Hong, Hu Zhiliang, Xu Chuanjun 2020, 5 (1):  56-59.  Abstract ( 481)    PDF (959KB) ( 1074 )    AIDS-associated with cryptococcal meningitis is a fatal infectious disease in the central nervous system, which is the main cause of HIV-related mortality worldwide. The clinical manifestations show the disease has a chronic process. The main clinical manifestations include fever (low fever and moderate fever), progressive headache, severe mental disorder, drowsiness, and etc. The location of cryptococcal meningitis lesions has certain characteristics, which can show abnormal signals in the both sides of basal ganglia. The imaging feature is the change of Virchow Robin space (VRS), which can be manifested as the dilated VRS gelatinous pseudocyst, and the damage of brain parenchyma. After cryptococcus infection breaks through the blood-brain barrier, it can form granuloma in brain parenchyma, that with ependyma or choroid plexus with the size of 5-20 mm. On contrast-enhanced MRI, mild or moderate enhancement of the lesions can be seen. Clinical diagnosis can be made by the location of the lesions and the characteristics of enhancement.

Education Fields

Imaging diagnosis and differential diagnosis of acquired immunodeficiency syndrome patients complicated pulmonary cryptococcal Xu Chuanjun 2020, 5 (1):  60-64.  Abstract ( 231)    PDF (839KB) ( 1202 )    Pulmonary cryptococcal is an important opportunistic infection and one of the important causes of death in AIDS patients. Early diagnosis and treatment are an important factor to improve the prognosis. As a non-invasive examination, imaging examination plays an important role in the early diagnosis and differential diagnosis of cryptococcal infection. There is a general understanding of the imaging changes of non-AIDS patients complicated pulmonary cryptococcal , but there are few literature reports on the imaging characteristics of AIDS patients, and so far there is no characteristic imaging performance recognized by radiologists. Through literature review, combined with the retrospective analysis of our confirmed cases of AIDS-related pulmonary cryptococcal , we found that there are still some characteristic changes, in which the single nodule with central cavity is the most common sign. Mastering these characteristics is very helpful for the early diagnosis of cryptococcal infection in AIDS patients.