Current Issue

2017 Vol.2 No.1 Published:28 February 2017

Forum of Specialist

Prevention and control of emerging infectious diseases,an eternal topic of mankind WU Shi-pin 2017, 2 (1):  1-4.  Abstract ( 263)    PDF (854KB) ( 2096 )    Emerging infectious disease is an infectious disease that has newly appeared in population or has been known for some time but is rapidly increasing in incidence or expanding in geographic range. Many major infectious diseases in human history have caused great disaster to human beings. Since 1970s,there are emerging infectious diseases in almost every year. Over the past 30 years,more than 40 emerging infectious diseases have emerged in the world. Emerging infectious diseases have become the focus of public health in the world. There are some unique epidemic characteristics of emerging infectious diseases in recent years.There are a variety of pathogens,but the virus is the most common. One of the remarkable characteristics is zoonotic. The spread of emerging infectious diseases is fast,and the range of the affected area is large. Infection route is complicated and changeable,and the prediction of epidemic tendency is difficult. Emerging infectious disease has a huge impact on the public health. Prevention of emerging infectious diseases include increasing government investment in public health,strengthening the construction of emerging infectious disease monitoring system and strengthening the scientific research and vaccine development of emerging infectious diseases.

Automated systems for microscopic and radiographic tuberculosis screening Fleming Y.M.Lure, Stefan Jaeger, Sameer Antani 2017, 2 (1):  5-9.  Abstract ( 612)    PDF (1200KB) ( 865 )    China has the world's second largest tuberculosis epidemic(after India) with very high TB infection,TB incident,drug resistance,and mortality rate. Rapid,accurate diagnosis is critical for timely initiation of treatment and ultimately control of the disease. WHO-recommended smear fluorescent microscopy is the most common diagnostic tools in the laboratories to detect acid fast bacilli(AFB) after staining with Auramine-O. Routine visual slide screening for identification and counting of AFB is a tedious,labor-intensive task. Low quality,inconsistent slide staining technique,debris,variation in human perception,and fatigue lead to sensitivity as low as 40%, especially in scanty specimens. Applying an automatic microscopy system using artificial intelligence based computer aided diagnostic(CAD) technologies to the automated diagnosis of TB presents the opportunity to address the shortcomings of current techniques in diagnosing TB from sputum smears. For the identification of TB suspects in low-resource settings,WHO has recommended chest X-ray (CXR) screening as a very efficient triage referral test. A challenge in those regions,however,is the imbalance in the affected population and available radiology services. In addressing this need, application of CAD using artificial intelligence into a low-cost automated tool for pulmonary TB (PTB) in CXR images can directly close this gap.

Original Articles

Analysis for epidemic trend of tuberculosis bacteria resistant to isoniazid and rifampin in Shenzhen from 1999 to 2015 LU Chun-rong, TAN Wei-guo, ZHUO Zhi-peng, WU Qing-fang, GUAN Hong-yun, JI Le-cai, YU Wei-ye 2017, 2 (1):  10-13.  Abstract ( 128)    PDF (937KB) ( 637 )    Objective To provide evidence for developing scientific prevention and control strategies by analyzing the epidemic trends of tuberculosis bacteria resistant to Isoniazid(H),tuberculosis bacteria resistant to rifampicin(R),and multidrug-resistant situation in Shenzhen. Methods A total of 17 144 patients with smear-positive pulmonary tuberculosis were registered in Shenzhen during 1999-2015. Here were 16,846 strains identified as mycobacterium tuberculosis by cultured strain identification,which were used to analyze the epidemic trends of H,R,and multidrug-resistant situation. Results Among the 16,846 tuberculosis patients,2458(14.59%) cases had household registration and 14 388(85.41%) cases were floating population. The total multidrug-resistance rate was 4.14%(697/16,846),the initial multidrug-resistance rate and the acquired multidrug-resistance rate were 3.22%(509/15,793) and 17.85%(188/1053) respectively;70.69%(697/986) of H were multidrug-resistant tuberculosis in the 17 years. There were a downtrends in the frequentness of H and R,total multidrug-resistance rate and initial-resistance rate in the past 17 years(P<0.05). There was no down trend in the multidrug-resistance rate among the retreatment patients(P>0.05). Conclusion The floating population was the focus of tuberculosis prevention and control in Shenzhen. Totally,there was a down trend of multidrug-resistance rate in the past 17 years,but the multidrug-resistance rate among the retreatment patients was significantly higher than that among the untreated patients,and H were more likely to develop into multidrug-resistant tuberculosis. It is still needed to strengthen the TB control strategy,improve the quality of governance continuously,and curb the MDR-TB epidemic effectively.

DTI study to assess the white matter structural integrity in HIV patients after HAART DENG Wen-juan, ZHAO Ting-ting, JIN Guan-qiao, HU Xue-ying, SU Dan-ke, WEI Bo, WU Nian-ning, GAO Fei-fei 2017, 2 (1):  14-17.  Abstract ( 130)    PDF (1980KB) ( 602 )    Objective To investigate the feasibility and effect of diffusion tensor imaging study in assessing the white matter structural integrity in HIV patients after highly active antiretroviral therapy(HAART) for therapeutic effect evaluation. Methods 74 HIV patients,including 28 HIV infectors with HAART and 48 HIV infectors without HAART,were randomly selected who underwent conventional MRI and DTI. Fractional anisotropy(FA) and apparent diffusion coefficient(ADC) values were measured in several regions:anterior limbs of internal capsule,posterior limbs of internal capsule,genu of internal capsule and genu of corpus callosum, splenium of corpus callosum and trunk of corpus callosum. The differences of mean FA value and ADC value between the two groups were compared by independent sample t test. Results Compared with patients without HAART group,FA values in anterior limbs of internal capsule,genu of corpus callous,splenium of corpus callous,and trunk of corpus callous in patients with HAART group had a significant increase(P<0.05).Moreover,there is no significant difference of FA values in the genu of internal capsule,posterior limbs of internal capsule and all the ROIs between the two groups(P>0.05). Conclusions DTI is a simple and noninvasive method for evaluating the change of white matter structural integrity in HIV patients and assessing the effect of HAART on white matter integrity. Besides,the changes of quantitative DTI value(FA) indicate that HAART may inhibit or lessen the damage to white matter caused by HIV.

To detect UGT1A1 gene polymorphism for neonatal patients with high blood bilirubin by using multiple real-time fluorescent quantitative PCR technique WEI Xiao-lan, LUO Zi-yi, WU Yu-mei, CHE Fang, LIU Xue-mei, LIU Fan 2017, 2 (1):  18-21.  Abstract ( 132)    PDF (1129KB) ( 750 )    Objective To detect UGT1A1 gene polymorphism for neonatal patients with high blood bilirubin by using multiple real-time fluorescent quantitative PCR technique and to discuss the relationship between UGT1A1 gene polymorphism and neonatal bilirubin level. Methods We chose 165 patients with high neonatal bilirubin（bilirubin≥257μmol/L） as the test group and 150 general subjects(bilirubin<257μmol/L) as control group in authors’hospitals between January 2015 and January 2016. DNA was extracted firstly from the whole blood;four common mutations of UGT1A1 gene were chosen,including A(TA)7TAA box of the promoter,and the Pro229Gln,Try486Asp,Gly71Arg in the coding region;primers and probe were synthesized;and samples were detected by multiple real-time fluorescent quantitative PCR technique and the fluorescence was collected;and the samples with positive results were recovered and purified for gene sequencing. Results The results of multiple real-time fluorescent quantitative PCR were consistent with the results of gene sequencing. The detection rates of A(TA)7TAA box mutation in test group and control group were 7.8% and 23.3% respectively,while the rate of Gly71Arg mutation in the test group and control group were 52.7% and 19.3% respectively,and the difference was statistically significant. However,the detection rates of Try486Asp and Pro229Gln mutation were relatively low with no statistical significance. In the test group,the bilirubin level of patients with homozygous Gly71Arg was higher than that of wild type or heterozygous mutations,and the difference was statistically significant. Conclusion Multiple real-time fluorescent quantitative PCR technique is a convenient, accurate,efficient and economic way to detect gene mutation,and the neonatal hyperbilirubinemia is associated with Gly71Arg mutations.

Comparative study on the risk factors,symptoms and complications between sputum smear positive pulmonary tuberculosis and sputum smear negative pulmonary tuberculosis GUO Jian-qiong, YAN Xiao-feng, YANG Song 2017, 2 (1):  22-24.  Abstract ( 434)    PDF (851KB) ( 870 )    Objective To compare the differences on the risk factors,symptoms and complications between sputum smear positive pulmonary tuberculosis and sputum smear negative pulmonary tuberculosis,so as to provide the scientific evidences for diagnosis,prognosis and the control of infectious sources. Methods A non matching case-control method,selection of activities during the period of January 2014 to December 2015 of sputum smear positive and smear negative pulmonary tuberculosis patients in 126 cases,76 patients were diagnosed as sputum smear positive pulmonary tuberculosis and 50 cases were smear negative pulmonary tuberculosis. All cases data were collected. χ2 values,odds raitios(OR),relative risk(RR) and 95% confidence interval were calculated respectively. The differences among the risk factors,symptoms and prognosis between the patients with smear positive pulmonary tuberculosis and smear negative pulmonary tuberculosis were analyzed by statistical method. Results There is no significant difference in the distributions of sex and occupation between the two groups. The single variable analysis showed that pulmonary cavities,hypoproteinem-ia,history with retreated pulmonary tuberculosis were independent risk factors being associated with smear positive pulmonary tuberculosis. The prevalence of expectoration,complication of pneumonia and anemia between the two groups had significant differences. Conclusions The risk factors of sputum smear positive pulmonary tuberculosis were pulmonary cavities,hypoproteinemia and history with retreated pulmonary tuberculosis. The incidence of expectoration,pneumonia or anemia of patients with sputum smear positive pulmonary tuberculosis were significantly higher than the cases with sputum smear negative pulmonary tuberculosis. Therefore,the sputum management of smear positive pulmonary tuberculosis with retreated pulmonary tuberculosis history,pulmonary cavities is important,and positiveprevention and early treatment of pneumonia or anemia will play a very crucial role in the diseases control and improvement of cure rate.

Clinical features of tuberculosis patients with pyrazinamide resistance LI Feng, LU Yong-hui, LI Tao, XIA Lu, QIAN Xue-qin, WU Wen-juan, LU Shui-hua 2017, 2 (1):  25-27.  Abstract ( 492)    PDF (851KB) ( 773 )    Objective To investigate the clinical features of tuberculosis patients with pyrazinamide(PZA) resistance. Methods Twenty-two patients who were hospitalized in our hospital during 2007-2010 were analyzed and followed up. Drug sensitivity test were performed for the cultured Mycobacterium tuberculosis. Pyrazinamide resistant gene-pncA was amplified by PCR and analyzed for mutation by DNA sequencing. Results Genotypes of PZA resistance are consistent with the results of phenotype in all 22 mycobacterium tuberculosis strains. PZA resistance was detected positive in 11 cases,and negative in the other 11 strains. Among the 11 PZA resistant strains,4 strains were examined to be multi-drug resistant strains. Patients with PZA resistant occupied 70%(7/10) in the retreatment cases,and 80%(4/5) in the multi-drug resistant patients. Among all pyrazinamide resistant cases,through follow-up,it revealed that 2 cases died,3 cases accepted intermittent treatment(failure),and 6 cases were cured.However,among the PZA sensitive patients,all were recovered except one death. Conclusion Pyrazinamide resistance is common in the patients with recurrent tuberculosis and multi-drug tuberculosis,and they have a relatively worse prognosis compared with those with PZA sensitive tuberculosis.

MRI imaging of brucellar spondylitis：a report of 5 cases in non-epedemic area and literature review GONG Jing-shan, ZHU Jin, LING Ren-nan, YANG Min-jie, XU-Jian-min 2017, 2 (1):  28-30.  Abstract ( 162)    PDF (1167KB) ( 784 )    Objective To describe the MR imaging findings of brucellar spondylitis and to review the relative literatures,so as to improve the radiologists’recognization of this disease in non-epidemic area and guide clinicians to give correct diagnosis and treatment in time. Methods MR imaging findings of 5 patients with clinical-proven brucellar spondylitis were retrospectively analyzed and literatures were reviewed to understand the different diagnosis of brucellar spondylitis from spinal tuberculosis and Modic 1 type changes of vertebral endplate. Results Lumber spine was involved among all the 5 patients,with unifocal osteomyelitis in one patient and multi-focal osteomyelitis in the remaining 4 patients. The vertebral architecture kept intact in all the patients. Paraspinal soft tissue involvement was noted in 2 patients,which manifested as multiple small abscesses and soft tissue edema. Combining with clinical files,these MRI manifestations were characteristiced by facilitate the differentiation diagnosis from spinal tuberculosis and Modic 1 type changes of vertebral endplate. Conclusions There are some MR imaging characteristics of brucellar spondylitis,such as diffuse vertebral osteomyelitis with intact vertebral architecture and minimal paraspinal soft tissue involvement. Combining with clinical files, a suggestive diagnosis of brucellar spondylitis can be made by these MR imaging characteristics．

Drug-resistance analysis of 3309 strains of mycobacterium tuberculosis FU Liang, ZHANG Pei-ze, DENG Guo-fang, LIU Hou-ming, YE Tao-sheng 2017, 2 (1):  31-34.  Abstract ( 172)    PDF (880KB) ( 732 )    Objective Drug resistances of 3309 strains of Mycobacterium tuberculosis(MTB) were analyzed in Shenzhen to provide scientific evidence for the treatment planning of drug-resistant tuberculosis. Methods Clinically isolated culture-positive MTB obtained from Jan 2011 to Sep 2015 in Shenzhen Third People's Hospital were retrospectively studied.The bacterial type was identified as Mycobacterium tuberculosis complex. Susceptibility of the strains to antituberculosis drugs was tested. Statistical analyses were performed using the SPSS19.0. Differences of the distributions of the strains in various years were analyzed by χ2 test. Differences were considered as significant if P<0.05. Results The total drug resistance rate of the 3309 strains was about 34.90%,the multidrug-resistance(MDR) rate was about 12.06%,and the extensively drug-resistance(XDR) rate was about 2.33%. For both the sensitive strains and drug-resistance strains,there were significant differences between their distributions in different years(χ2=43.409、43.670,and P=0.000、0.000). No significant difference was found between the distributions of MDR group a in different years(χ2=5.531,P=0.237). Considering the drug-resistance degrees,isoniazid got the highest resistance rate of 19.64%,while protionamide got the lowest resistance rate of 2.18%. Conclusion The total drug resistance rate and MDR of tuberculosis patients in our hospital were both relatively high. Drug resistances should be paid enough attention to select reasonable therapeutic regimen for tuberculosis patients with drug resistant.

CT diagnosis and differential diagnosis of nodular or mass type pulmonary cryptococcosis QI Wan-ling, XIA Qing, LI Zhi, LI Zhong, HE Yu-lin 2017, 2 (1):  35-39.  Abstract ( 183)    PDF (1391KB) ( 1684 )    Objective To investigate the diagnostic value of the multi-slice spiral CT (MSCT) on diagnosing nodular or mass type pulmonary cryptococcosis(PC). Methods A total of 23 cases with nodular or mass type PC confirmed by pathological examinations in our hospital were retrospectively studied.Both plain and enhanced CT scans were performed for 16 patients, while direct enhanced CT scan was performed for 7 patients. The data including size,number,distribution and density of the lesions,performance of enhanced CT scan and accompanying signs were analyzed. Results Of all the 23 patients,there were 7 cases of single nodules/masses and 16 cases of multiple nodules/masses. There were totally 276 lesions with 267 nodules and 9 masses.The lesions were mainly found in outer zone or sub pleura of the lung(20 cases). Sixteen patients underwent both plain and enhanced CT scans,in which 12 cases(75%) showed heterogeneous enhancement and 10 cases(62.5%) showed moderate enhancement.Nodular or mass type lesions were accompanied by many CT signs including air bronc-hogram(65.2%,15/23),pulmonary vascular thickening(56.5%,13/23),halo sign(30.4%,7/23),pulmonary cavity or vocule sign(39.1%,9/23),lobulation sign(52.2%,12/23),spicule sign(34.7%,8/23),and pleural indentation(4.3%,1/23). Conclusions PC lesions usually occur in right lung and locations close to pleura.Pulmonary vascular thickening,air bronchogram and halo sign are the characteristic findings of CT manifestations in nodular or mass type PC.

Analysis of 162 cases of infectious endocarditis XI Wen-na, GONG Wen-lan, YAN Jing, LUO Jie 2017, 2 (1):  40-42.  Abstract ( 167)    PDF (1241KB) ( 732 )    Objective To investigate the pathogenic microorganism,clinical characteristics of infectious endocarditis(IE),in order to improve the level of diagnosis. Method This was a retrospective study of 162 cases of IE collected in our hospital. Result ①Congenital heart disease accounted for 94.4% of the underlying diseases while 9 patients has no underlying heart disease;②149 cases were treated with bacterial culture,the outcome was positive in 82 cases(55%),among which 47 patients were infected with streptococcus,17 with staphylococcus,6 with Gram-negative bacterium,3 with enterococcus faecalis,4 with mixed bacteria;③Fever was the most common clinical manifestation,which occurred in 148 patients. 98 patients have fevered last for one month and the most up to one year. 74.7% cases hemogram was raised;Other clinical manifestations include 69 cases microscopic hematura,21 cases urinary occult blood test(+++),123 cases anemia,121 cases with valve excrescence,cerebral infarction in 15 cases. While 4 patients had cerebral infarction as first symptom,spleen infarction in 4 cases,1 case spleen infarction combined with cerebral hemorrhage,1 case spleen infarction combined with left kidney infarction. Conclusion For patients with long time fever,anemia,occult blood test intensive positive,cardiac neoplasm IE was easy diagnosed;but for those patients had spleen,kidney,cerebral infarction or cerebral hemorrhage as first symptom,should be consider IE.

CT and MRI manifestations of gallbladder tuberculosis LIU Heng, BO Yong-hua, LU Hong 2017, 2 (1):  43-45.  Abstract ( 447)    PDF (1909KB) ( 1008 )    Objective To improve the understanding and diagnostic level of the gallbladder tuberculosis(GT) by analyzing its CT and MRI findings. Methods CT and MRI findings of 5 patients with GT proved by clinical pathology were collected and analyzed.CT scan was performed in 5 cases, including enhanced scan in 2 cases,and both CT scan and MRI scan were carried out in 1 cases. Results CT scan showed that the gallbladder wall was thickened,the density of the cyst was uniform or non-uniform,and the boundary of the gallbladder was clear or vague. The enhancement of the gallbladder wall was slightly enhanced,and the enhancement was seen in the capsule. As to MRI scan, ovoid abnormal signal was noticed in the gallbladder area,central lesions showed slightly short T1 and long T2 signals while surrounded lesions showed strip-like short T1 and short T2 signal,and slightly shorter T1,T2 signals with half ring shape were found in the outer sphere. The features of gallbladder tuberculosis,such as the shape,size,edge,density and signal of the lesion,and the degree of enhancement are helpful for differential diagnosis. Conclusion GT may has some specific CT and MRI characteristics,which facilitate to make a correct preoperative diagnosis,especially combined with relevant clinical data,and provide a theoretical evidence for clinical treatment and prognosis.

Imaging findings and therapeutic evaluation of pneumonia caused by human infected H7N9 avian influenza virus DENG Ying-ying, HUANG Hua, YUAN Jing, LI Hong-jun, LU Pu-xuan 2017, 2 (1):  46-49.  Abstract ( 133)    PDF (1079KB) ( 707 )    Objective The purpose of this study was to characterize the clinical and radiological findings of H7N9 avian influenza virus infection. Methods A retrospective review of 37 patients suffering from H7N9 avian influenza virus infection was performed.Thoracic X-ray and CT results of the patients and clinical data were available. Results 5 patients had absolutely contact with avian. Consolidation lesions and GGOs were found in the lungs of all 37 patients,and all consolidation and GGOs absorbed quickly after antiviral therapy. After treatment,streaks and interlobular septa thickening were both found in 33 patients.Pleural arcs were found in 16 patients. Conclusion The most common imaging findings were consolidation and GGOs in the lungs of patients with H7N9 avian influenza virus infection. After treatment of antiviral therapy,most of the lesions absorbed quickly,and a small number of the lesions such as streaks left in the lung,suggesting early lung fibrosis.