Current Issue

2025 Vol.10 No.6 Published:31 December 2025

Interpretation of WHO Tuberculosis Reports and Guidelines

WHO 2025 global tuberculosis report 2025 key data analysis for the world and China He Huawei, Huang Aichun, Li Wei, Jiang Changyue, Xu Chaoyan, Meng Xiayan, Li Zhifeng, Huang Xianzhen, Zhu Qingdong, Fu Liang, Lu Puxuan, Xie Zhouhua 2025, 10 (6):  1-9.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.001 Abstract ( 413)    PDF (825KB) ( 266 )    The WHO Global Tuberculosis Report 2025 shows that there were 10.7 million new tuberculosis(TB) cases globally in 2024, with China accounting for approximately 6.5% of global incidence, ranking 4th among the 30 high TB burden countries. Global TB deaths totaled approximately 1.23 million, with China making significant progress in mortality control. In 2024, there were approximately 390 000 cases of multidrug-resistant/rifampicin-resistant TB globally; of these, China had about 27 700 cases. From 2015 to 2024, TB incidence cumulatively decreased by 12%, and deaths decreased by 29%, but approximately 47% of TB patients and their families still face catastrophic expenditures. This falls significantly short of the World Health Organization End TB Strategy milestone targets of "reducing TB incidence by 50% and mortality by 75% by 2025 compared to 2015." In 2024, 8.3 million TB patients were newly diagnosed and reported globally, the highest number since WHO began monitoring global TB data, but approximately 2.4 million fewer than estimated, reflecting challenges in case detection and reporting. Although global TB diagnostic and treatment services show recovery trends after the COVID-19 pandemic, new challenges such as reduced international aid funding remain. World Health Organization calls on countries to further increase investment in TB, promote preventive treatment, and expand the application of innovative tools. Based on global data, China has made breakthrough progress in improving coverage of rapid diagnostic technologies and expanding preventive treatment, but monitoring of drug-resistant TB and effective control of medical expenditures still need strengthening. To achieve the strategic goal of "ending TB by 2035," future efforts require deepened collaborative cooperation among multiple sectors including health, education, justice, social security, and civil affairs to form long-term governance synergy and jointly promote systematic and sustainable development of TB prevention and control.

Global tuberculosis epidemiology and "End TB Strategy" progress, 2014-2024: a longitudinal analysis of WHO global tuberculosis reports Fu Liang, Deng Guofang, Lu Shuihua 2025, 10 (6):  10-15.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.002 Abstract ( 117)    PDF (712KB) ( 96 )    Based on the series of annual data from the global tuberculosis reports released by the WHO between 2015 and 2025. this study analyzed the changing trends of core epidemiological indicators related to tuberculosis (TB) globally and in China from 2014 to 2024. In accordance with the preset data framework, the study extracted annual data on TB incidence count, incidence rate, mortality count, and the disease burden of multidrug/rifampicin-resistant TB (MDR/RR-TB) from the WHO global tuberculosis reports, and conducted a longitudinal comparative analysis of the above-mentioned core indicators at the global level and in China. The results showed that during the period from 2014 to 2024, the estimated global TB incidence count remained at the scale of 10 million cases, changing from approximately 9.6 million cases to around 10.7 million cases. the incidence rate decreased from about 133 per 100 000 population to 131 per 100 000 population; the number of TB-related deaths dropped from roughly 1.5 million cases to 1.23 million cases; and the estimated incidence count of MDR/RR-TB declined from about 480 000 cases to 390 000 cases. During the same period, in China, the estimated TB incidence count decreased from 889 000 cases to 696 000 cases; the incidence rate fell from around 65 per 100 000 population to about 49 per 100 000 population, with its proportion of the global incidence count dropping from 8.6% to 6.5%. The estimated incidence count of MDR/RR-TB in China also showed a downward trend (decreasing from approximately 65 000 cases in 2019 to about 28 000 cases in 2024), accounting for roughly 7.1% of the global total in 2024. In conclusion, since 2014, the overall TB incidence rate and mortality count have shown a decreasing trend both globally and in China. However, there remains a certain gap compared with the 2025 reduction targets for TB incidence and mortality set by the "End TB Strategy". Meanwhile, although the burden of TB in China has continued to ease, the country still faces considerable pressure in the prevention and control of TB and MDR/RR-TB on a global scale.

Practical origins and application considerations of the WHO Consolidated Guidelines on Tuberculosis Module 4: Treatment Care and Support Wu Di, Liu Zhihui, Yang Jianuo, Chen Liang 2025, 10 (6):  16-23.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.003 Abstract ( 76)    PDF (766KB) ( 78 )    On April 15, 2025, the WHO officially released the WHO Consolidated Guidelines on Tuberculosis Module 4: Treatment and Care. This guideline represents a significant departure from the previous domain-specific guidance model. By organically integrating the treatment and care systems for tuberculosis patients, it constructs an integrated clinical practice framework. Based on three relevant guidelines issued in 2022, including WHO Consolidated Guidelines on Tuberculosis Module 4: Treatment of Drug-Susceptible Tuberculosis, WHO Consolidated Guidelines on Tuberculosis Module 4: Treatment of Drug-Resistant Tuberculosis (2022 Update), and WHO Consolidated Guidelines on Tuberculosis, Module 4: Tuberculosis Care and Support, this guideline systematically incorporates the latest research achievements in the field of tuberculosis diagnosis and treatment. Its core updated content focuses on the 6-month and 9-month treatment regimens for rifampicin-resistant pulmonary tuberculosis formed on the basis of two key clinical trials providing new evidence-based medical basis for the short-course treatment of drug-resistant tuberculosis.For tuberculosis control workers and clinical medical staff, this guideline not only serves as an important reference for clinical decision-making and disease control but also puts forward requirements for comprehensive and in-depth thinking on its practical application. To realize the efficient implementation and innovative application of the guideline, it is necessary to thoroughly trace its practical foundation and developmental process, accurately grasp its core tenets, and flexibly apply it in combination with clinical practice. This paper intends to conduct a systematic discussion from three dimensions: interpretation of the guideline's core tenets, analysis of its practical origin, and reflections on its clinical application, aiming to provide references for tuberculosis-related workers to accurately understand and scientifically apply the guideline and help promote the achievement of the global goal of "ending tuberculosis". The practice traceability analysis of the recommended regimens will be highly beneficial for clinical applications. This paper will conduct an in depth exploration from three perspectives: the key points of the guidelines, the practice traceability, and the considerations regarding application.

Original Articles

Activity of novel β-lactamase inhibitor combinations against carbapenem-resistant Klebsiella pneumoniae: an in vitro study Ma Ke, Zhang Baofang, Xu Wei, Zhang Quan 2025, 10 (6):  24-31.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.004 Abstract ( 66)    PDF (10973KB) ( 14 )    Objective To systematically elucidate the susceptibility profiles of carbapenem-resistant Klebsiella pneumoniae (CRKP) to novel β-lactamase inhibitor combinations through integrated bioinformatics analysis and in vitro antimicrobial susceptibility testing, thereby providing scientific evidence for optimizing clinical anti-infective treatment strategies. Method Performed broth micr-dilution assays to evaluate the susceptibility of 146 CRKP clinical isolates (collected from March to August 2023) to relebactam-, vaborbactam-, avibactam-, and taniborbactam-based combination regimens. Whole-genome sequencing was conducted, and molecular characteristics were analyzed using Kleborate. Phylogenetic reconstruction was performed using Snippy. Result Antimicrobial susceptibility testing demonstrated that β-lactam/β-lactamase inhibitor combinations (imipenem-relebactam, meropenem-vaborbactam, ceftazidime-avibactam, aztreonam-avibactam, fcefepime-taniborbactam) exhibited significantly enhanced activity compared to monotherapies, with minimum inhibitory concentrations (MICs) decreased to 1/32 of the original value or lower, the susceptibility rates of all tested compound formulations exceeded 90%. Aztreonam-Avibactam (100%) and Fcefepime-Taniborbactam (99.3%) showed the highest efficacy. Molecular analysis revealed ST11 (84.2%) and KL64 (79.4%) as predominant sequence and capsular types, respectively. Carbapenem resistance was primarily mediated by blaKPC-2 (90.4%), while high-frequency mutations in OmpK35 (91.8%) and OmpK36 (84.3%) also constituted the resistance mechanisms. Phylogenetic analysis indicated polyclonal transmission, with OXA-232-producing strains forming distinct clusters, suggesting potential adaptive advantages. Conclusion Novel β-lactamase inhibitor combinations demonstrated potent activity against CRKP isolates in our hospital. However, the emergence of resistant strains underscores the need for further investigation into resistance mechanisms and enhanced epidemiological surveillance.

Epidemiological characteristics and influencing factors of anemia in patients with HIV coinfected with Talaromyces marneffei Qin Rusu, Zheng Yanqing, Qin Xiaoying, Lyu Jiannan, Huang Tianren, Lu Yibo, Zou Jun 2025, 10 (6):  32-37.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.005 Abstract ( 60)    PDF (740KB) ( 23 )    Objective This retrospective study analyzed data from patients co-infected with HIV and Talaromyces marneffei(TM) at Nanning Fourth People's Hospital. Its objectives were to compare the epidemiological differences between anemic and non-anemic cohorts, identify determinants influencing anemia development. The findings aim to inform clinical risk stratification and enable precision interventions. Method The study population consisted of HIV-infected patients with Talaromyces marneffei co-infection who were hospitalized for the first time at Nanning Fourth People’s Hospital between 2012 and 2023. Subjects were identified according to predefined inclusion and exclusion criteria. Demographic, clinical, and laboratory data were extracted from the hospital’s electronic medical record system. Anemia status was assigned using the WHO diagnostic criteria, permitting categorization into anemic and non-anemic groups and further stratification by anemia severity. Statistical analyses were performed with SPSS 25.0. Inter-group differences in epidemiological characteristics and clinical manifestations were assessed by univariate methods including t test, X2 test, and non-parametric tests as appropriate. Multivariable Logistic regression was used to identify independent determinants of anemia. Result A total of 2296 HIV/TM co-infected patients admitted to Nanning Fourth People’s Hospital between 2012 and 2023 were enrolled. The cohort comprised 1841 (80.2%) males and 455(19.8%) females, with a mean age of (45.19±14.41) years. Anemia was present in 1937 patients(84.4%), among these, 881(45.5%) had mild, 887(45.8%) moderate, and 169(8.7%) severe anemia. Compared with non-anemic subjects, anemic patients exhibited higher proportions of individuals aged ≥60 years, disease onset during summer, positive TM blood cultures, and thrombocytopenia (all P<0.05). Lymphocyte subset analyses revealed that CD3+, CD4+, and CD8+ T-cell counts were significantly lower in the anemia group (P<0.05).Across anemia severity strata, significant differences were observed in the frequencies of fatigue, anorexia, diarrhea, gastrointestinal bleeding, hepatosplenomegaly, lymphadenopathy, and skin rash (P<0.05).Multivariable Logistic regression identified the following independent risk factors for anemia: positive TM blood culture (OR=1.410, 95%CI: 1.030-1.930), age≥60 years (OR=1.702, 95%CI:1.222-2.371), and thrombocytopenia (OR=1.928, 95%CI: 1.484-2.503). Conversely, concomitant diabetes mellitus（OR=0.322, 95%CI: 0.179-0.579） and higher CD4+ T-cell counts（OR=0.637, 95%CI：0.442-0.917） were associated with a reduced risk. Conclusion Among HIV/Talaromyces marneffei co-infected patients, the incidence of anemia is markedly elevated. As anemia severity increases, manifestations such as hepatosplenomegaly, lymphadenopathy, and cutaneous eruptions become more prevalent, necessitating vigilant monitoring for early intervention. In clinical practice, particular attention should be directed to older patients, with close tracking of T. marneffei blood-culture results, platelet counts, and CD4+ T-cell levels to promptly recognize and mitigate the therapeutic and prognostic risks imposed by anemia.

Distribution characteristics and future suitable area prediction of Biomphalaria straminea in Guangdong Province based on integrated species distribution model Lu Qian, He Yingjun, Shen Peilin, Chen Panjue, Gao Shitong 2025, 10 (6):  38-45.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.006 Abstract ( 47)    PDF (2767KB) ( 27 )    Objective The purpose is to analyze the suitable habitat distribution of Biomphalaria straminea in Guangdong Province using current climate and land characteristics and to assess the changes in these habitats under future climate scenarios. Method We collected distribution data of B. straminea through field surveys, literature reviews, and search online database (https://www.gbif.org). Species distribution models, including support vector machine, random forest, generalized additive model, gradient boosting machine, and multivariate adaptive regression splines, were constructed using the R package "SSDM" and environmental factors. The best-performing model was selected to build an ensemble species distribution model (ESDM) to predict the suitable habitat distribution in Guangdong Province under current and future scenarios. Result Research revealed that that human footprint, isothermality and aspect are the most significant environmental and socio-economic factors driving the distribution of Biomphalaria straminea. Under current conditions, highly suitable habitats for B. straminea are concentrated in the Pearl River Delta and Chaoshan regions, covering an area of approximately 26 100km². Under future scenarios, the suitable range for B. straminea is predicted to expand significantly, and the average area of suitable habitats under the SSP3-7.0 scenario is consistently larger than that under the SSP1-2.6 scenario. Conclusion Human activities, isothermality, and aspect are the main factors driving the invasion of Biomphalaria straminea. Simultaneously, future climate change will become a critical factor influencing its potential geographical distribution and diffusion trend, significantly increasing the risk of the snail's south-to-north spread. This urgently requires the government to formulate targeted and forward-looking monitoring and control strategies to prevent Schistosomiasis mansoni, for which Gastrocopta armilla acts as an intermediate host, from forming new endemic areas in Southern China.

Resting-state brain functional changes in cognitively normal HIV-infected individuals: evidence from amplitude of low-frequency fluctuation and regional homogeneity Wang Yuanyuan, Yang Bo, Pang Meiyi, Jia Yonghong, Zhao Lingling, Wang Wei 2025, 10 (6):  46-51.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.007 Abstract ( 50)    PDF (942KB) ( 22 )    Objective Traditional neuropsychological assessments have insufficient sensitivity in identifying early brain function abnormalities in HIV-infected individuals. This study aims to explore the application potential of amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) indices derived from resting-state functional magnetic resonance imaging (rs-fMRI) in detecting brain function abnormalities in HIV-infected individuals with normal cognitive function, reveal preclinical neurofunctional changes before the onset of clinical symptoms, and provide neuroimaging evidence for the early screening and "preclinical" evaluation of HIV-associated neurocognitive disorders (HAND). Method Twenty-three cognitively normal PLWH confirmed by neuropsychological assessment and 25 healthy controls underwent rs-fMRI scanning from January 2023 to June 2025 at Beijing You'an Hospital affiliated with Capital Medical University. ALFF and ReHo maps were calculated separately. Between-group differences were examined with two-sample t-tests (AlphaSim correction, P<0.05). Result ALFF analyses revealed significantly increased ALFF in the right post-central gyrus, left angular gyrus, and bilateral supramarginal gyri, along with decreased ALFF in the bilateral middle frontal gyri and right superior frontal gyrus in PLWH compared with controls. ReHo analyses showed elevated ReHo in the right post-central gyrus, right supramarginal gyrus, and right angular gyrus, and decreased ReHo in the left occipital pole in PLWH relative to controls. All differences were statistically significant (P<0.05). Conclusion Even in the cognitively normal stage, PLWH exhibit prominent resting-state brain functional abnormalities, characterized by hypoactivity in prefrontal regions and hyperactivity in posterior parietal regions. ALFF and ReHo can serve as sensitive indices for detecting preclinical functional alterations in HAND, offering a potential neuroimaging basis for early screening and intervention.

Clinical application of electromagnetic navigation bronchoscopy-assisted preoperative localization of pulmonary nodules in HIV-infected/AIDS patients Gong Sheng, Li Dan, Wang Ning, Li Gang, Liu Yu, Jiang Liangshuang, Yao Xiaojun 2025, 10 (6):  52-56.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.008 Abstract ( 52)    PDF (1128KB) ( 27 )    Objective To analyze the clinical data of HIV-infected/AIDS patients undergoing preoperative localization of pulmonary nodules with electromagnetic navigation bronchoscopy, summarize its safety and efficacy, and provide evidence for promoting this technique among HIV-infected/AIDS populations. Method A retrospective study included patients with pulmonary nodules and HIV infection/AIDS who visited Chengdu Public Health Clinical Medical Center from September 2023 to December 2024. All patients underwent electromagnetic navigation bronchoscopy-assisted preoperative localization of pulmonary nodules followed by fluorescence-guided thoracoscopic surgery. Baseline data, surgical outcomes, nodule location, density, pathological results, and surgical approaches were collected for statistical description and analysis. Result This study included 17 patients with pulmonary nodules and HIV infection/AIDS. Among them, 8 patients had solitary pulmonary nodules, 8 had unilateral multiple nodules, and 1 had bilateral multiple nodules. A total of 28 pulmonary nodules were preoperatively localized using electromagnetic navigation bronchoscopy, with an average size of (7.61±3.16) mm. In terms of anatomical distribution, there were 11 nodules (39.29%) in the right upper lobe, 3 nodules (10.71%) in the right middle lobe, 6 nodules (21.43%) in the right lower lobe, 6 nodules (21.43%) in the left upper lobe, and 2 nodules (7.14%) in the left lower lobe.In terms of pathological classification of nodules, there were 10 pure ground-glass nodules (35.71%), 14 mixed ground-glass nodules (50.00%), and 4 solid nodules (14.29%). The average distance from the pulmonary nodules to the visceral pleura was (11.41±5.68) mm, and the average procedure duration was (21.29±5.49) min. The localization success rate was 96.4% (27/28), with no related complications occurring. Postoperative pathological results showed that among the 28 preoperatively localized nodules from 17 patients, there were 2 cases of adenocarcinoma in situ (7.14%), 10 cases of minimally invasive adenocarcinoma (35.71%), 3 cases of invasive adenocarcinoma (10.71%), 3 cases of granuloma (10.71%), and 10 cases of inflammatory nodule (35.71%). Conclusion In patients with pulmonary nodules complicated by HIV infection/AIDS, electromagnetic navigation bronchoscopy-assisted preoperative localization of pulmonary nodules offers rapid, safe, and effective positioning while reducing occupational exposure risks for operators. It provides an optimal preoperative localization strategy for this special population and merits clinical promotion and application.

Bone mineral density characteristics and associated factors in HIV-infected/aids patients receiving antiretroviral therapy: a cross-sectional study based on dual-energy X-ray absorptiometry Hou Keke, Yang Jia, He Jianglin, Li Tao, Zhang Shuying, Wan Ting, Xiong Lei, Gao Yueqin, Fu Siqi, Zhang Na 2025, 10 (6):  57-62.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.009 Abstract ( 124)    PDF (1218KB) ( 30 )    Objective To evaluate the application value of dual-energy X-ray absorptiometry (DXA) in the quantitative assessment of bone mineral density (BMD) among patients with HIV infection/AIDS receiving antiretroviral therapy (ART), and to identify key factors associated with BMD alterations, so as to provide evidence for optimizing bone health management during ART. Method A total of 185 HIV-infected/AIDS patients admitted to the Department of Infectious Diseases of Chengdu Public Health Clinical Medical Center between January and December 2024 were retrospectively enrolled. Demographic characteristics, body mass index (BMI), and ART regimens were collected. According to the DXA results, patients were categorized into a normal bone mass group and a bone mass abnormality group (including osteopenia and osteoporosis). Clinical characteristics and BMD indices were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminatory power of age, sex, and the use of tenofovir disoproxil fumarate (TDF) in predicting bone mass abnormality. Result Among the 185 participants, 119 (64.32%) were male and 66 (35.68%) were female, with a mean age of (59.38±11.92) years. Bone mass abnormality was identified in 137 patients (74.05%). Compared with patients aged ≤50 years, male patients, and those not receiving TDF treatment, patients aged >50 years, female patients, and those receiving TDF treatment all had a significantly higher incidence of abnormal bone mass (all P<0.05). ROC analysis showed that the combined model incorporating female sex, age >50 years, and TDF use achieved an area under the curve (AUC) of 0.781 (95%CI: 0.700-0.862, P<0.001), with a sensitivity of 0.920 and a specificity of 0.521. Conclusion The prevalence of bone mass abnormality is 74.05% among HIV-infected/AIDS patients receiving ART. Female sex, age >50 years, and TDF exposure are associated with an increased risk of bone mass abnormality. A multivariate prediction model combining these three factors improves the diagnostic performance for bone mass abnormality and may support risk stratification and clinical management of bone health in HIV-infected/AIDS patients.

Relationship between cerebrospinal fluid lactate level and craniocerebral MRI findings and prognosis of tuberculous meningitis Huang Zhiqiang, Wu Shaoquan, Zhou Bangjian, Tian Yongpan, Wu Jixiang, Peng Yunhang 2025, 10 (6):  63-69.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.010 Abstract ( 43)    PDF (1303KB) ( 31 )    Objective To explore the correlation between lactate level of cerebrospinal fluid (CSF) and cranial magnetic resonance imaging (MRI) manifestations and prognosis of tuberculous meningitis (TBM) patients, so as to provide a basis for diagnosis and prognosis of TBM. Method This study adopted a retrospective analysis method. A total of 48 patients with TBM admitted to Chongqing Dazu District People's Hospital from January 2020 to February 2023 were included and followed up for 6 months. The adverse clinical outcome was death or severe disability 6 months after admission. Patients with death or severe disability were included in the adverse outcome group (n=16), and patients with a Glasgow outcome scale (GOS) of 4 or 5 were included in the good outcome group (n=32). All patients underwent MRI examination, and CSF lactate levels were analyzed by automatic biochemical analyzer. Result Compared with the good outcome group, the CSF lactate level in the bad outcome group was significantly higher [(4.07±2.42)mmol/L vs (6.59±3.44)mmol/L, t=2.946, P=0.005]. Receiver operating characteristic curve analysis showed that CSF lactate level predicted 6-month clinical outcome of TBM patients with an area under the curve of 0.838 (95% CI: 0.688-0.988) at the optimal cut-off value (4.36 mmol/L), the sensitivity and specificity of the prediction were 87.5% and 84.4%, respectively. Multivariate Logistics analysis determined that CSF lactate level >4.36 mmol/L was an independent risk factor for death in TBM patients within 6 months. TBM patients with CSF lactate level >4.36 mmol/L were more likely to have MRI findings of basal ganglia region, thalamus, cerebellum cerebral infarction and hydrocephalus (P<0.05). Conclusion TBM patients with a CSF lactate level >4.36 mmol/L of admission are more likely to present with cerebral infarction and hydrocephalus findings on MRI. This indicator is also an independent risk factor for mortality within 6 months in TBM patients, and serves as an important indicator for assessing the prognosis of TBM patients.

Analysis of pathogen distribution, risk factors and prognosis in patients with pulmonary tuberculosis complicated by pneumonia Ma Yanli, Tian Yanxia, Yang Na, Wang Xiaomin 2025, 10 (6):  70-74.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.011 Abstract ( 54)    PDF (723KB) ( 17 )    Objective The distribution of pathogenic bacteria, possible high-risk factors and prognosis of patients with tuberculosis complicated with pneumonia were analyzed to provide reference for clinical diagnosis and treatment strategies of this kind of patients. Method This study analyzed 352 tuberculosis patients treated at the General Hospital of the Eastern Theater Command of the People's Liberation Army from December 2015 to December 2023. Sputum samples were collected from all patients with tuberculosis complicated by pneumonia to examine pathogen distribution patterns. Multivariate Logistic regression was employed to identify factors contributing to tuberculosis-related pneumonia. Patients developing severe pneumonia underwent one-year follow-up with mortality data analysis to assess the proportion of risk factors among fatalities. Result Among 352 tuberculosis patients included in this study, 156 patients developed pneumonia, with an incidence rate of 44.32%. Through pathogen detection of these patients, a total of 305 bacterial strains were isolated. Among them, Gram-negative bacteria accounted for the most significant proportion, reaching 60.66%. Multivariate Logistic regression analysis showed that diabetes（OR=1.417,95%CI：1.141-1.708）, hypertension（OR=1.494,95%CI：1.114-1.874）, chronic bronchitis（OR=1.431,95%CI：1.106-1.741）, continuous use of broad-spectrum antibiotics for 3 weeks or longer（OR=1.531,95%CI：1.177-1.879）, continuous use of glucocorticoids for 2 weeks or longer（OR=1.628,95%CI：1.241-2.015）, disease duration 5 years or longer（OR=1.459,95%CI：1.118-1.752）, retreatment with pulmonary tuberculosis(OR=1.605,95%CI：1.205-2.005), malnutrition(OR=1.741,95%CI：1.201-2.234), failure to fully adhere to prescribed medications（OR=1.372,95%CI：1.078-1.666）, and serum 25-hydroxyvitamin D levels <30ng/ml（OR=1.369,95%CI：1.087-1.716） were independent risk factors for pneumonia in pulmonary tuberculosis patients (all P<0.05). Of the 156 pulmonary tuberculosis patients with pneumonia, 59 (37.82%) developed severe pneumonia. During the one-year follow-up, 14 of the 59 patients (23.73%) died. Among the pulmonary tuberculosis patients who died, the highest proportion (92.86%) had been on broad-spectrum antibiotics for 3 weeks or longer. Conclusion Patients with tuberculosis complicated by pneumonia are predominantly infected with Gram-negative bacteria. Risk factors for pneumonia development in tuberculosis patients include diabetes, hypertension, chronic bronchitis, prolonged use of broad-spectrum antibiotics (≥3 weeks), continuous corticosteroid therapy (≥2 weeks), disease duration ≥5 years, recurrent tuberculosis, malnutrition, non-compliance with medical instructions, and serum 25-hydroxyvitamin D levels <30 ng/ml. Among tuberculosis patients who developed pneumonia and died within one year, over 90% had sustained use of broad-spectrum antibiotics for ≥3 weeks. Therefore, clinical practice should prioritize rational administration of broad-spectrum antibiotics in such patients to reduce mortality risks.

Prognosis analysis of hematological malignancies complicated by pulmonary mucormycosis based on clinical and chest imaging data Zhu Mengying, Li Hongmei, Li Ziwei, Zhao Yunshu, Han Shuting, Lu Ziwei, Wang Xin, Li Yonggang 2025, 10 (6):  75-80.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.012 Abstract ( 48)    PDF (1351KB) ( 22 )    Objective To assess the clinical, laboratory, and chest CT data and identify prognostic factors in patients with hematological malignancies complicated by pulmonary mucormycosis. Method We retrospectively collected clinical, laboratory and chest imaging data from patients with hematological malignancies complicated by pulmonary mucormycosis who were admitted to the First Affiliated Hospital of Soochow University from January 2017 to June 2023. Patients were divided into a survival group (n=20) and a death group (n=26) and their clinical profiles, laboratory findings, and chest imaging characteristics were compared. The Kaplan-Meier survival analysis was used to identify the univariate factors affecting prognosis. Cox regression analysis was employed to evaluate factors associated with the risk of death. Result Kaplan-Meier analysis revealed that an unrelieved state of the bone marrow status of the primary disease (χ2=7.872, P=0.005), granulocytopenia at the initial diagnosis of mucormycosis infection (χ2= 5.160, P=0.023), renal insufficiency (χ2=5.818, P=0.016), hemoptysis (χ2=4.080, P=0.043), and pleural effusion (χ2=8.718, P=0.003) were associated with poor prognosis (P<0.05). Multivariate Cox regression analysis confirmed that non-remission of the primary disease bone marrow (OR=3.798, 95%CI 1.123-12.843) and pleural effusion (OR=3.176, 95%CI 1.180-8.549) were independent risk factors for poor prognosis (P<0.05), are independent risk factors for poor prognosis. The concordance index of this multivariate Cox regression model is 0.738, which indicates that the model has a moderate prognostic predictive performance. Conclusion Inadequate control of the primary hematological malignancy significantly increases mortality risk. Intensive management of the underlying hematological disease is critical for improving prognosis.

Application of multi-index joint evaluation in the disease progression of severe fever with thrombocytopenia syndrome: a study based on the mean platelet volume/lymphocyte ratio Weng Lyulei, Long Dongdi, Wu Yinling, Miao Jiali 2025, 10 (6):  81-86.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.013 Abstract ( 43)    PDF (792KB) ( 12 )    Objective To explore the effect of using a multi-index combined evaluation based on mean platelet volume/lymphocyte ratio (MPVLR) in the progression of fever with thrombocytopenia syndrome (SFTS) patients, provide scientific guidance for the diagnosis and treatment of SFTS patients. Method A retrospective of a total of 150 patients with SFTS from January 2017 to October 2024 admitted to Nanjing Lishui District People's Hospital were selected as the SFTS group. 150 patients with fever accompanied by normal platelets during the same period were selected as the fever accompanied by normal platelets group, 150 patients without fever accompanied by thrombocytopenia were selected as the non fever accompanied by thrombocytopenia group, and 150 healthy individuals who underwent physical examination during the same period were selected as the control group. The levels of MPVLR, interleukin-11 (IL-11), C reactive protein (CRP), mean platelet volume (MPV), lymphocyte (LYM), neutrophil (NEUT), white blood cell (WBC), lactate dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB), alanine aminotransferase (ALT), and aspartate amino transferase (AST) of patients with different degrees of illness in the four groups were compared, and univariate and multivariate Logistic regression analyses were conducted. Receiver operating characteristic (ROC) curves were plotted to clarify the predictive value of multi-index joint evaluation for the progression of SFTS. Result There were statistically significant differences in the levels of MPVLR, IL-11, and CRP among the four groups (P<0.05). Among 150 SFTS patients, a total of 88 cases (58.67%) were classified as mild symptoms, and 62 cases (41.33%) were classified as severe symptoms. The results of one-way factor analysis showed that MPVLR, IL-11, CRP, LDH, CK-MB, ALT and AST levels in severe group were higher than those in mild group (P<0.05). The results of multiple Logistic regression analysis showed that MPVLR (OR=2.639, P<0.05), IL-11 (OR=4.127, P<0.05), and CRP (OR=2.693, P<0.05) were independent factors affecting the progression of SFTS. The ROC curve showed that the area under the curve of MPVLR, IL-11 and CRP combined to predict the progression of SFTS was 0.856, which was higher than that of MPVLR (area under the curve was 0.823), IL-11 (area under the curve was 0.752) and CRP (area under the curve was 0.745) alone (P<0.05). Conclusion The expression levels of MPVLR, IL-11, and CRP are relatively high in SFTS patients, especially in severe SFTS patients. The combined evaluation of multiple indicators has high clinical value in predicting the progression of SFTS and can serve as an important basis for disease diagnosis and treatment planning.

Analysis of pathogen spectrum of bacterial and fungal coinfections in 291 pulmonary tuberculosis patients based on nanopore sequencing Zhu Qingdong, Zhao Chunyan, Huang Aichun, Zeng Chunmei, Li Weiwen, Chen Canling, Song Chang 2025, 10 (6):  87-92.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.014 Abstract ( 61)    PDF (725KB) ( 25 )    Objective This study aimed to delineate the pathogen-spectrum characteristics of bacterial and fungal co-infections in pulmonary tuberculosis (PTB) patients by means of third-generation nanopore sequencing,in order to provide scientific basis for the clinical diagnosis and treatment of PTB combined infection. Method A total of 291 PTB patients admitted to the Fourth People's Hospital of Nanning from November 2021 to August 2024 were enrolled. Nanopore sequencing was employed for pathogen profiling. SPSS 26.0 was used to analyse detection rates and seasonal, age- and sample-type distributions with the χ2 test. Result The three most frequently detected bacteria were Haemophilus influenzae, Prevotella melaninogenica and Rothia mucilaginosa. Among fungi, Candida albicans, Aspergillus fumigatus, and Pneumocystis jirovecii/Malassezia restricta (tied) predominated. Bacterial infections peaked in spring and summer; the detection rates of the three leading bacteria and A. Fumigatus in spring were significantly higher than in summer (P<0.05). The three main bacteria were more common in patients≤60 years, whereas Candida albicans was more prevalent in those>60 years (P<0.05). Detection rates of the three bacteria in bronchoalveolar-lavage fluid were significantly higher than in puncture tissue, abscess/thoracic fluid or cerebrospinal fluid (P<0.05). Conclusion We identified the core dominant pathogens of bacterial and fungal co-infection in PTB patients.The main types of bacteria are Haemophilus influenzae, Prevotella melaninogenica, and Rothia mucilaginosa; the main types of fungi are Candida albicans, Aspergillus fumigatus, Pneumocystis jirovecii, and Malassezia restricta. Bacterial co-infections are most frequent in spring and summer. Patients aged≤60 years are more prone to the three leading bacterial infections, whereas those>60 years are more susceptible to Candida albicans. For these bacteria, bronchoalveolar-lavage fluid provides the highest detection yield.

Review

Research progress on the renal safety of tenofovir alafenamide in HIV-infected individuals Wang Siyuan, Zhang Lukun, He Yun 2025, 10 (6):  93-100.  DOI: 10.19871/j.cnki.xfcrbzz.2025.06.015 Abstract ( 48)    PDF (735KB) ( 27 )    Most reverse transcriptase inhibitors among antiretroviral therapy drugs are predominantly eliminated via the renal pathway. Drug accumulation may exert an adverse impact on renal function in HIV-infected patients. Among these agents, the nephrotoxicity of tenofovir disoproxil fumarate has long been a major concern, as its relatively high plasma tenofovir exposure is associated with an increased risk of renal and skeletal adverse events. Tenofovir alafenamide is a prodrug of tenofovir, which exhibits high virologic suppression efficacy while reducing plasma tenofovir exposure by approximately 90%. Consequently, tenofovir alafenamide has a significantly lower potential for renal toxicity compared with tenofovir disoproxil fumarate. Numerous clinical trials and real-world studies have demonstrated that antiretroviral therapy regimens containing tenofovir alafenamide confer favorable renal safety profiles in HIV-infected patients. This review summarizes the current evidence and relevant literature regarding the renal safety of tenofovir alafenamide-containing antiretroviral therapy regimens in HIV-infected patients with different renal function statuses, aiming to provide clinical guidance and references for the rational use of tenofovir alafenamide in the treatment of HIV-infected patients.