1
|
Khan S, Ahmad F, Ansari MI, Ashfaque M, Islam MH, Khubaib M. Toxin-Antitoxin system of Mycobacterium tuberculosis: Roles beyond stress sensor and growth regulator. Tuberculosis (Edinb) 2023; 143:102395. [PMID: 37722233 DOI: 10.1016/j.tube.2023.102395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/15/2023] [Accepted: 08/10/2023] [Indexed: 09/20/2023]
Abstract
The advent of effective drug regimen and BCG vaccine has significantly decreased the rate of morbidity and mortality of TB. However, lengthy treatment and slower recovery rate, as well as reactivation of the disease with the emergence of multi-drug, extensively-drug, and totally-drug resistance strains, pose a serious concern. The complexities associated are due to the highly evolved and complex nature of the bacterium itself. One of the unique features of Mycobacterium tuberculosis [M.tb] is that it has undergone reductive evolution while maintaining and amplified a few gene families. One of the critical gene family involved in the virulence and pathogenesis is the Toxin-Antitoxin system. These families are believed to harbor virulence signature and are strongly associated with various stress adaptations and pathogenesis. The M.tb TA systems are linked with growth regulation machinery during various environmental stresses. The genes of TA systems are differentially expressed in the host during an active infection, oxidative stress, low pH stress, and starvation, which essentially indicate their role beyond growth regulators. Here in this review, we have discussed different roles of TA gene families in various stresses and their prospective role at the host-pathogen interface, which could be exploited to understand the M.tb associated pathomechanisms better and further designing the new strategies against the pathogen.
Collapse
Affiliation(s)
- Saima Khan
- Department of Biosciences, Integral University, Lucknow, India
| | - Firoz Ahmad
- Department of Biosciences, Integral University, Lucknow, India
| | | | | | | | - Mohd Khubaib
- Department of Biosciences, Integral University, Lucknow, India.
| |
Collapse
|
2
|
Qi CC, Xu LR, Zhao CJ, Zhang HY, Li QY, Liu MJ, Zhang YX, Tang Z, Ma XX. Prevalence and risk factors of tuberculosis among people living with HIV/AIDS in China: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:584. [PMID: 37674103 PMCID: PMC10481577 DOI: 10.1186/s12879-023-08575-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To estimate the prevalence and risk factors associated with tuberculosis (TB) among people living with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) in China. METHODS A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. After the literature was screened based on the inclusion and exclusion criteria, STATA® version 17.0 software was used for the meta-analysis. The heterogeneity among study data was assessed using I2 statistics. Subgroup analysis and meta-regressions were performed to further explore the source of heterogeneity. RESULTS A total of 5241 studies were retrieved. Of these, 44 studies were found to be eligible. The pooled prevalence of HIV/TB co-infection was 6.0%. The risk factors for HIV/TB co-infection included a low CD4+ T cell count, smoking, intravenous drug use and several other sociodemographic and clinical factors. Bacillus Calmette-Guérin (BCG) vaccination history was a protective factor. CONCLUSION A high prevalence of TB was observed among people living with HIV/AIDS in China. Low CD4+ T cell count, smoking, and intravenous drug use were the primary risk factors for HIV/TB co-infection, whereas BCG vaccination history was a protective factor. Checking for TB should be prioritized in HIV screening and healthcare access. SYSTEMATIC REVIEW REGISTRATION Registered on PROSPERO, Identifier: CRD42022297754.
Collapse
Affiliation(s)
- Cong-Cong Qi
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Li-Ran Xu
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China.
- Key Laboratory in Chinese Medicine for the Prevention and Treatment of Viral Diseases in Henan Province, Zhengzhou, Henan Province, China.
- The First Affiliated Hospital of Henan University of Chinese Medicine, Renmin Road 19, Jinshui District, Zhengzhou City, Henan Province, 450000, China.
| | - Chang-Jia Zhao
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Hai-Yan Zhang
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Qing-Ya Li
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Mei-Jun Liu
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Ye-Xuan Zhang
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Zhou Tang
- Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Xiu-Xia Ma
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| |
Collapse
|
3
|
Wang Y, Li Z, Li F. Impact of Previous Pulmonary Tuberculosis on Chronic Obstructive Pulmonary Disease: Baseline Results from a Prospective Cohort Study. Comb Chem High Throughput Screen 2023; 26:93-102. [PMID: 35388750 DOI: 10.2174/1386207325666220406111435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pulmonary tuberculosis (PTB) is a significant risk factor for COPD, and Xinjiang, China, has a high incidence of pulmonary tuberculosis. The effects of tuberculosis history on airflow restriction, clinical symptoms, and acute episodes in COPD patients have not been reported in the local population. Besides, the exact relationship between lung function changes in people with a history of tuberculosis and COPD risk is not clear. METHODS This study is based on the Xinjiang baseline survey data included in the Natural Population Cohort Study in Northwest China from June to December, 2018. Subjects' questionnaires, physical examination, and lung function tests were performed through a face-to-face field survey to analyze the impact of previous pulmonary tuberculosis on local COPD. Furthermore, we clarified the specific relationship between pulmonary function decline and the probability of developing COPD in people with a history of tuberculosis. RESULTS A total of 3249 subjects were eventually enrolled in this study, including 87 with a history of tuberculosis and 3162 non-TB. The prevalence of COPD in the prior TB group was significantly higher than that in the control group (p-value = 0.005). First, previous pulmonary tuberculosis is an essential contributor to airflow limitation in the general population and patients with COPD. In all subjects included, pulmonary function, FEV1% predicted (p-value < 0.001), and FEV1/FVC (%) (p-value < 0.001) were significantly lower in the prior TB group than in the control group. Compared to non-TB group, FEV1% prediction (p-value = 0.019) and FEV1/FVC (%) (p-value = 0.016) were found to be significantly reduced, and airflow restriction (p-value = 0.004) was more severe in prior TB group among COPD patients. Second, COPD patients in the prior TB group had more severe clinical symptoms. Compared with no history of tuberculosis, mMRC (p-value = 0.001) and CAT (p-value = 0.002) scores were higher in the group with a history of tuberculosis among COPD patients. Third, compared with the non-TB group, the number of acute exacerbations per year (p-values=0.008), the duration of each acute exacerbation (p-values=0.004), and hospitalization/ patient/year (p-values<0.001) were higher in the group with a history of tuberculosis among COPD patients. Finally, a dose-response relationship between FEV1/FVC (%) and the probability of developing COPD in people with previous pulmonary TB was observed; when FEV1/FVC (%) was < 80.8, the risk of COPD increased by 13.5% per unit decrease in lung function [0.865(0.805, 0.930)]. CONCLUSION COPD patients with previous pulmonary tuberculosis have more severe airflow limitations and clinical symptoms and are at higher risk for acute exacerbations. Furthermore, lung function changes in people with a history of tuberculosis were associated with a dose-response relationship with the probability of developing COPD.
Collapse
Affiliation(s)
- Yide Wang
- Department of Integrated Pulmonology, The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, 830000, P.R. China
- National Clinical Research Base of Traditional Chinese Medicine in Xinjiang, Urumqi, 830000, P.R. China
| | - Zheng Li
- Department of Integrated Pulmonology, The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, 830000, P.R. China
- National Clinical Research Base of Traditional Chinese Medicine in Xinjiang, Urumqi, 830000, P.R. China
| | - Fengsen Li
- Department of Integrated Pulmonology, The Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, 830000, P.R. China
- National Clinical Research Base of Traditional Chinese Medicine in Xinjiang, Urumqi, 830000, P.R. China
| |
Collapse
|
4
|
Zhang Y, Lu P, Wu K, Zhou H, Yu H, Yuan J, Dong L, Liu Q, Lu W, Yang H, Cao D, Zhu L. Positive rate and risk factors of latent tuberculosis infection among persons living with HIV in Jiangsu Province, China. Front Cell Infect Microbiol 2023; 13:1051060. [PMID: 36960041 PMCID: PMC10029977 DOI: 10.3389/fcimb.2023.1051060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
Objective To analyze the latent tuberculosis infection (LTBI) among persons living with HIV(PLWH) in Jiangsu Province, to explore the factors affecting the positive rate of LTBI, and to take appropriate measures to control tuberculosis (TB) infection. Methods A cross-sectional study was conducted among PLWH in Jiangsu Province from June to July 2021. All PLWH in Jiangsu Province were used as the study population. Currently, the diagnosis of LTBI lacks a "gold standard" and can only be assisted by the immunological method. In this study, Tuberculin skin test (TST), ESAT6-CFP10 test (EC), and QuantiFERON-TB gold in-tube (QFT) were used to detect the positive rate of LTBI among PLWH and to analyze their risk factors. Results A total of 340 prisoners were included, 89.7% were male, the median age was 38 years [Interquartile Range (IQR):32-46 years], these patients were on Antiviral Therapy (ART), and median CD4 counts was 376 (IQR: 261-496), 103 (30.3%) were positive in at least one test, LTBI by TST was 16.5%, LTBI by EC was 15.9%, LTBI by QFT was 26.2%. Univariate analysis showed the results for TST, EC, and QFT were not affected by CD4 counts (p>0.05), and multivariate analysis showed that a history of incarceration was associated with an increased risk of positive TST (adjusted odds ratio [aOR]=1.98;95% CI,1.03-3.82), EC (aOR=2.65;95% CI,1.37-5.12) and QFT (aOR=2.01;95%CI,1.12-3.57), in addition, female gender was associated with increased risk of positive TST (aOR=3.66;95%CI,1.60-8.37) and EC (aOR=3.43;95%CI,1.46-8.07), and contact history of TB patients was associated with increased risk of TST (aOR= 2.54;95%CI,1.23-5.22) and QFT (aOR=2.03;95%CI,1.03-3.99), and ethnic minorities (aOR=0.26;95%CI,0.12-0.57), longer duration of incarceration was associated with an increased risk of positive QFT (aOR=1.12;95%CI,1.02-1.24). Conclusions Female gender, and ethnic minorities, history of incarceration, longer duration of incarceration, and contact history of TB patients are risk factors for LTBI among PLWH in Jiangsu Province, and attention should be paid to TB control in this population.
Collapse
Affiliation(s)
- Yu Zhang
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
- School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Kai Wu
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Hongxi Zhou
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Haibing Yu
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Ju Yuan
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Lang Dong
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
| | - Haitao Yang
- School of Public Health, Southeast University, Nanjing, Jiangsu, China
- Health Policy Research Department, Jiangsu Provincial Health Development Research Center, Jiangsu, China
| | - Dianyi Cao
- Jiangsu Prison Administration, Central Hospital, Changzhou, Jiangsu, China
- *Correspondence: Limei Zhu, ; Dianyi Cao,
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu, China
- *Correspondence: Limei Zhu, ; Dianyi Cao,
| |
Collapse
|
5
|
Cui Z, Huang F, Liang D, Huang Y, Qin H, Ye J, Huang L, Zhou C, Huang M, Liang X, Long F, Zhao Y, Lin M. Tuberculosis among Ambulatory People Living with HIV in Guangxi Province, China: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12280. [PMID: 36231580 PMCID: PMC9565094 DOI: 10.3390/ijerph191912280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aims to determine the prevalence of TB among ambulatory people living with HIV in Guangxi Province, which experienced the biggest HIV epidemic in China. METHODS We undertook a longitudinal study in five HIV/AIDS designated hospitals randomly selected from Guangxi Province; all newly diagnosed HIV/AIDS outpatients from 2019 to 2021 were screened for TB and interviewed with a questionnaire. RESULTS A total of 4539 HIV/AIDS outpatients were enrolled, with 2886 (63.6%) men and 1653 (26.4%) women. The prevalence of TB/HIV coinfection was 0.8%, with a clear downward trend from 1.3% in 2019 to 0.4% in 2021 (p = 0.0011). The prevalence of LTBI was 24.3%, with no significant differences from 2019 to 2021. The percentages of AIDS, comorbidity, nine symptoms and abnormal chest X-ray of TB were higher than those of the other PLWH. CONCLUSION The prevalence of TB among ambulatory people with HIV in Guangxi Province was 14 times higher than the general population, and the annual declined TB prevalence indicated the effectiveness of TB and HIV control and prevention over recent years. The findings proved that symptom screening was insufficient for TB diagnosis and highlighted the importance of systematic TB screening at every visit to a health facility.
Collapse
Affiliation(s)
- Zhezhe Cui
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Fei Huang
- National Center for TB Control and Prevention, China CDC, Beijing 100013, China
| | - Dabin Liang
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Yan Huang
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Huifang Qin
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Jing Ye
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Liwen Huang
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Chongxing Zhou
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Minying Huang
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Xiaoyan Liang
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| | - Fengxue Long
- School of Public Health, Guangxi Medical University, Nanning 530021, China
| | - Yanlin Zhao
- National Center for TB Control and Prevention, China CDC, Beijing 100013, China
| | - Mei Lin
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China
| |
Collapse
|
6
|
Assessment of knowledge, attitude, and practices of tuberculosis patients towards DOTs regimen in Jimma health center, Jimma zone, southwest Ethiopia. J Clin Tuberc Other Mycobact Dis 2022; 28:100329. [PMID: 35958355 PMCID: PMC9361319 DOI: 10.1016/j.jctube.2022.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of conducting this study was to assess the knowledge, attitude, and practices of tuberculosis patients towards dots regimen in Jimma health Center. In addition, assessing the attitude of tuberculosis towards factors, modern, and traditional medicine was another aim of this study. Methods A cross-sectional study was conducted based on patient card and registration book at TB follow-up clinic at Jimma health center, southwest Ethiopia. The study population comprises 150 participants, who were selected from the patient registration book by interviewing and questionnaires. Additionally, cross-tabulation and OR with 95% confidence interval were computed. Results In this study, only 103 (68.7%) and 47 (31.3%) patients scored higher and lower knowledge status respectively. Of the total enrolled governmental employee, 25 (16.7 %) patients had an overall high knowledge status. On the other hand, 101 (67.3%) and 49 (32.7 %) patients scored high and low overall attitude respectively. Conclusions In this study, the knowledge and attitude of patients about TB and its treatment were found within a low level of perception. Therefore, implementation of health education and awareness creation through different mobilization mechanisms are required to avoid the problem for patients.
Collapse
|
7
|
Wang Y, Jing W, Liu J, Liu M. Global trends, regional differences and age distribution for the incidence of HIV and tuberculosis co-infection from 1990 to 2019: results from the global burden of disease study 2019. Infect Dis (Lond) 2022; 54:773-783. [PMID: 35801264 DOI: 10.1080/23744235.2022.2092647] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV) are more likely to develop tuberculosis (TB), and their co-infection (HIV-TB) increases the risk of death. We aimed to describe the global trends, regional differences and age distribution of HIV-TB. METHODS Annual new cases, age-standardized incidence rates (ASRs) and age-specific incidence rates with 95% uncertainty intervals (UIs) of HIV-infected drug-susceptible tuberculosis (HIV-DS-TB), HIV-infected multidrug-resistant tuberculosis without extensive drug resistance (HIV-MDR-TB) and HIV-infected extensively drug-resistant tuberculosis (HIV-XDR-TB) during 1990-2019 were collected from the Global Burden of Disease Study 2019. To reveal the trends of HIV-TB by region and age, the percentage change of new cases and estimated annual percentage change (EAPC) of ASRs were calculated. RESULTS The ASR of HIV-XDR-TB increased significantly by an average of 14.77% (95% CI: 11.05%-18.62%) per year during 1990-2019 worldwide, while the ASRs of HIV-DS-TB and HIV-MDR-TB decreased after 2005. HIV-XDR-TB was a great threat to Eastern Europe for the largest number of new cases (792, 95% UI: 487-1167) and the highest ASR (0.34 per 100,000 population, 95% UI: 0.21-0.50). In addition, Oceania had the largest rise in ASRs of HIV-MDR-TB (EAPC = 22.56, 95% CI: 18.62-26.64) and HIV-XDR-TB (EAPC = 32.95, 95% CI: 27.90-38.20) during 1990-2019. Recently, age-specific incidence rates of HIV-XDR-TB increased in all age groups, especially in the 50-69 age groups among high, low-middle and low Socio-Demographic Index regions. Additionally, the proportion of patients aged <15 years was nearly 10% of new cases in sub-Saharan Africa in 2019, which was higher than in other regions. CONCLUSIONS HIV-infected drug-resistant TB is common in Oceania and Eastern Europe. Moreover, HIV-XDR-TB among elderly people became increasingly prevalent. In the future, the collaboration of management for HIV and TB should be intensified in Oceania and Eastern Europe, and more concerns need to be paid in elderly people.
Collapse
Affiliation(s)
- Yaping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wenzhan Jing
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
8
|
Wu Y, Yang Y, Wei H, Jia L, Jiang T, Tian Y, Guo C, Zhang Y. Mortality predictors among patients with HIV-associated pulmonary tuberculosis in Northeast China: A retrospective cohort analysis. J Med Virol 2021; 93:4901-4907. [PMID: 33788289 DOI: 10.1002/jmv.26977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/31/2021] [Accepted: 03/18/2021] [Indexed: 11/07/2022]
Abstract
The coexistence of pulmonary tuberculosis (PTB) and human immunodeficiency virus (HIV) infection leads to high morbidity and mortality in these populations. Although antiretroviral therapy (ART) has decreased TB incidence in HIV-infected patients, this coexistence still prevails in China. Patients with HIV-PTB admitted to Beijing You An Hospital from 2014 to 2018 were retrospectively enrolled, and information on demographics, clinical characteristics, and laboratory findings were extracted from medical records. Predictors of death, including age (adjusted hazard ratio [AHR]: 1.03; 95% confidence interval [CI]: 1.00-1.05), tobacco use (AHR: 2.76; 95% CI: 1.54-4.94), history of tuberculosis (AHR: 3.53; 95% CI: 1.82-6.85), not being on ART (AHR: 2.94; 95% CI: 1.31-6.63), extrapulmonary tuberculosis (AHR: 2.391; 95% CI: 1.37-4.18), sputum smear positivity (AHR: 2.84; 95% CI: 1.61-4.99), CD4+ T cell count ≤ 50 cells/µl (AHR: 3.45; 95% CI: 1.95-6.10), and initiating ART ≥ 8 weeks after the initiation of antituberculous therapy (odds ratio: 3.30; 95% CI: 1.09-10.04). By contrast, there were no deaths among the six patients who began ART within 8 weeks after the initiation of antituberculous therapy. Age, tobacco use, not being on ART, extrapulmonary tuberculosis, sputum smear positivity, and CD4+ T cell count ≤50 cells/µl predict those patients at high risk of death among HIV-infected patients with PTB, and the time of initiating ART after the initiation of antituberculous therapy is also important for prognosis.
Collapse
Affiliation(s)
- Yongfeng Wu
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, China
| | - Yang Yang
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, China
| | - Huaying Wei
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, China
| | - Lin Jia
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, China
| | - Taiyi Jiang
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, China
| | - Yakun Tian
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, China
| | - Caiping Guo
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, China
| | - Yulin Zhang
- Department of Respiratory and Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, China
| |
Collapse
|
9
|
Liu E, Wang Q, Zhang G, Zhou L, Chen M. Tuberculosis/HIV Coinfection and Treatment Trends - China, 2015-2019. China CDC Wkly 2020; 2:924-928. [PMID: 34594802 PMCID: PMC8422363 DOI: 10.46234/ccdcw2020.252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/25/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eryong Liu
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Qian Wang
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Guoqin Zhang
- Tianjin Center for Tuberculosis Control, Tianjin, China
| | - Lin Zhou
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| | - Mingting Chen
- National Center for Tuberculosis Control and Prevention, China CDC, Beijing, China
| |
Collapse
|
10
|
Abstract
Background Cryptococcal prostatitis is a rare clinical disease and has never been reported in China. Case presentation We report on a male HIV-infected patient with pulmonary and prostate cryptococcosis that was misdiagnosed (as tuberculosis) and delayed diagnosed. Although the patients accepted anti-fungal treatment and anti-retroviral treatment finally, the physician’s mistakes reflect the rarity of this condition in China. Conclusion Cryptococcal prostatitis is a rare disease that unusually presents in immunodeficient patients. Physicians should have a heightened awareness of this particular infection in the immunodeficient population.
Collapse
|
11
|
Zhang J, Kern-Allely S, Yu T, Price RK. HIV and tuberculosis co-infection in East Asia and the Pacific from 1990 to 2017: results from the Global Burden of Disease Study 2017. J Thorac Dis 2019; 11:3822-3835. [PMID: 31656655 DOI: 10.21037/jtd.2019.09.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Periodic surveillance is crucial to provide information for resource allocation to control HIV/AIDS, tuberculosis (TB), and their co-infection, especially in areas with high morbidity and mortality like East Asia and the Pacific. Therefore, we examined the morbidity and mortality of HIV/AIDS and TB co-infection in this region from 1990 to 2017. Methods Utilizing the Global Burden of Disease (GBD) Study 2017, we obtained incidence, prevalence, and mortality numbers and rates of HIV/AIDS and TB co-infection, including HIV and drug-susceptible TB (DS-TB), multidrug-resistant TB without extensive drug resistance (MDR-TB without XDR), and extensive drug-resistant TB (XDR-TB). The trends in incidence, prevalence, and mortality from 1990 to 2017 for each co-infection type were analyzed using join-point regression modelling. Results In 2017, there were 238,372, 4,294, and 392 new cases of HIV-infected DS-TB, HIV-infected MDR-TB without XDR, and HIV-infected XDR-TB, respectively. The number of prevalent cases and deaths were 383,809 and 12,197 of HIV-infected DS-TB, 7,811 and 1,168 of HIV-infected MDR-TB without XDR, and 713 and 282 of HIV-infected XDR-TB. From 1990 to 2017, the age-standardized incidence rate and prevalence rate of HIV-infected DS-TB, and the prevalence rate of HIV-infected XDR-TB continuously increased; the incidence rate of HIV-infected XDR-TB increased from 1990 to 2005 before stabilizing. However, the incidence and prevalence rates of HIV-infected MDR-TB without XDR-as well as the mortality rates of all co-infection types-have decreased in the last 5 years. Conclusions Even though the mortality rates of all HIV and TB co-infection types have decreased recently, the overall trends in both incidence and prevalence rates of HIV-infected DS-TB and XDR-TB have been increasing since 1990. Efforts to control co-infection across drug resistance types should be continued and further strengthened.
Collapse
Affiliation(s)
- Jianrong Zhang
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | | | - Tiange Yu
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Rumi Kato Price
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
12
|
Jensen SB, Rudolf F, Wejse C. Utility of a clinical scoring system in prioritizing TB investigations - a systematic review. Expert Rev Anti Infect Ther 2019; 17:475-488. [PMID: 31159621 DOI: 10.1080/14787210.2019.1625770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Tuberculosis (TB) is among the 10 most common causes of death worldwide and it is the leading cause of mortality in people with human immunodeficiency virus (HIV). Clinical scoring systems have the potential to improve case finding and to prioritize patients for TB testing. Areas covered: This systematic review investigated the utility of prediction models to improve pulmonary tuberculosis (pTB) case finding. Studies were searched through PubMed until 15th of August 2018 and 20 studies were eligible according to the inclusion criteria. Data on study population, outcome measurements, predictors, and performance were extracted. Many studies showed promising results but lacked external validation. Furthermore, head-to-head studies are needed to compare the different prediction models. Sensitivities of the prediction models ranged from 26% to 96% and specificities from 18% to 92%, negative likelihood ratios (LR-) from 0.22 to 0.8 and positive likelihood ratios(LR+) 1.07 to 7.32. Composite scores including paraclinical measures added to sensitivity. Expert opinion: TB case finding is of utmost importance to advance the quest for global TB elimination, and simple measures to identify high-risk populations or persons to undergo further diagnostic evaluation are highly needed. A number of clinical scores are available and could be implemented in practice to improve case finding.
Collapse
Affiliation(s)
- Signe Bernth Jensen
- a GloHAU, Center for Global Health, Department of Public Health , Aarhus University , Aarhus , Denmark
| | - Frauke Rudolf
- b Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark.,c Bandim Health Project , Statens Serum Institute , Bissau , Guinea Bissau
| | - Christian Wejse
- a GloHAU, Center for Global Health, Department of Public Health , Aarhus University , Aarhus , Denmark.,b Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark.,c Bandim Health Project , Statens Serum Institute , Bissau , Guinea Bissau
| |
Collapse
|
13
|
Teweldemedhin M, Asres N, Gebreyesus H, Asgedom SW. Tuberculosis-Human Immunodeficiency Virus (HIV) co-infection in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2018; 18:676. [PMID: 30563476 PMCID: PMC6299573 DOI: 10.1186/s12879-018-3604-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 12/10/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) are the double burden diseases of the world. The African continent takes a great share of TB-HIV cases worldwide. This study was aimed to determine the prevalence of TB-HIV co-infection in Ethiopia, using a meta-analysis based on a systematic review of published articles. METHODS An electronic search was conducted in databases including PubMed, HINARI, EMBASE, Cochrane library and Google Scholar to extract the articles. Articles published between 1995 and November 2017 had been searched for using different keywords. The analysis was performed using MetaXL software and R statistical software (version 3.2.3). RESULT Our searches returned a total of (n = 26,746) records from 30 articles of which 21 were cross-sectional, 7 were retrospectives and 2 were prospective studies. The range of prevalence of TB-HIV co-infection was found to be from 6 to 52.1% with random effects pooled prevalence of 22% (95% CI 19-24%) and with substantial heterogeneity chi-square (X2) = 746.0, p < 0.001, (I2 = 95.84%). CONCLUSION Our analysis indicated that the prevalence of TB-HIV co-infection is high in Ethiopia with substantial regional variation. An integrated, facility-based and community-based effort towards the prevention, early detection and management of cases should be further strengthened throughout the country to mitigate the double burden disease.
Collapse
Affiliation(s)
- Mebrahtu Teweldemedhin
- Department of Medical Laboratory Sciences, College of Health Sciences, Aksum University, PO.BOX 298, Aksum, Tigray Ethiopia
| | - Negasi Asres
- Department of Public Health, College of Health Sciences, Aksum University, Aksum, Tigray Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Sciences, Aksum University, Aksum, Tigray Ethiopia
| | | |
Collapse
|
14
|
Zhang W, Han C, Wang MS, He Y. Characteristics and factors associated with treatment delay in pleural tuberculosis. QJM 2018; 111:779-783. [PMID: 30053223 DOI: 10.1093/qjmed/hcy167] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current strategies for the prevention, diagnosis and treatment of pleural TB have been inadequate, several challenges and issues related with pleural TB have been reported. AIM To summarize the main features of pleural tuberculosis (TB) and determine the risk factors in treatment delay. DESIGN Retrospective analysis of hospital records. METHODS Consecutive confirmed TB patients with pleural effusion were enrolled in the study. Demographic and epidemiological data were collected from electronic medical records. Treatment delay duration was stratified into two categories: <30 days and ≥30 days. Multivariate logistic regression analysis was used to evaluate risk factors for the delay. RESULTS From July 2011 to September 2015, a total of 723 patients were enrolled, 72.1% of patients had pulmonary TB, 8.9% had empyema, 8.9% were multidrug-resistant TB (MDR-TB). Multivariate analysis revealed that MDR-TB (odds ratios (OR) = 2.485, 95% confidence interval (CI) 1.347, 4.587), pulmonary TB (OR = 1.452, 95% CI 1.010, 2.087) and empyema (OR = 4.355, 95% CI 2.185, 8.680) were significant risk factors for treatment delay, while fever (OR= 0.519, 95% CI 0.362, 0.744) as well as pleural protein (≥45 g/l) (OR=0.470, 95% CI 0.332, 0.667) were the protective factors. CONCLUSION MDR-TB, pulmonary TB and empyema were significant risk factors for treatment delay, while fever and high pleural protein were protective factors. Tuberculous empyema remains a major problem in China, adequate awareness should be created for the management.
Collapse
Affiliation(s)
- W Zhang
- Department of Rehabilitation, Linyi People's Hospital, Linyi, Shandong, China
| | - C Han
- Department of Geriatrics, Shandong Mental Health Center, Jinan, Shandong, China
| | - M-S Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, Jinan, Shandong, China
| | - Y He
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| |
Collapse
|
15
|
Tuberculosis among Full-Time Teachers in Southeast China, 2005⁻2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092024. [PMID: 30227616 PMCID: PMC6163467 DOI: 10.3390/ijerph15092024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 12/20/2022]
Abstract
Objective: To explore the incidence rate and characteristics of tuberculosis (TB) among full-time teachers from 2005 to 2016 in southeast China and to provide a basis for TB prevention and control measures in schools. Methods: Information about full-time teachers with TB was obtained from the National Tuberculosis Information Management System (NTIMS). Population data were collected from the Zhejiang Statistical Yearbook and the Zhejiang Education Yearbook. The TB incidence rates and epidemiological characteristics of full-time teachers were analyzed and the Chi-square test was used to analyze influencing factors of epidemiological characteristics and clinical characteristics, case-finding delay, and treatment outcomes. Results: A total of 1795 teachers with TB were reported from 2005 to 2016, and the annual incidence rate was 28.87 per 100,000. The average annual PTB (pulmonary TB) incidence rate among full-time teachers was 25.43/100,000 from 2005 to 2016 and the average annual PTB incidence rate among students was 15.40/100,000 from 2005 to 2016. The highest average incidence rates were observed in the QZ (Quzhou) and HZ (Hangzhou) districts. The male-to-female ratio of the patients was 0.95:1. Approximately half of the patients were 15–40 years old. The mean case-finding interval was 45.3 days. Multivariable logistic regression analysis of TB case-finding delay among full-time teachers revealed that the older (OR = 1.44, 95% CI = 1.18–1.76, p < 0.01), not local (OR = 1.81, 95% CI = 1.20–2.73, p < 0.01), retreatment (OR = 2.06, 95% CI = 1.39–3.08, p < 0.01) and extra-pulmonary tuberculosis (OR = 1.71, 95% CI = 1.13–2.61, p = 0.01) cases were at high risk of case-finding delay. Compared to physical examination, patients detected by referrals and tracking (OR = 2.26, 95% CI = 1.16–4.38, p = 0.02) and patients who directly visited the designated TB hospital (OR = 2.00, 95% CI = 1.03–3.88, p = 0.04) were more prone to case-finding delay. The cure rate of full-time teachers with TB was 77.10%. The cure rates differed significantly between groups classified based on age, case-finding patterns, diagnostic results, treatment classifications, and strategies of patient management. Conclusion: The TB incidence rate among full-time teachers decreased from 2005 to 2016, but teachers suffered a higher risk of TB than students. Western Zhejiang was a hotspot for TB incidence among full-time teachers. Female teacher and young and middle-aged teacher cases account for the majority of the reported patients. There was a case-finding delay among full-time teachers with TB. We should conduct regular physical examinations and strengthen full-course supervision to reduce the risk of TB patients with case-finding delay and increase the TB cure rate.
Collapse
|
16
|
Gong X, Li Y, Wang J, Wu G, Mohemaiti A, Wushouer Q, Yao L, Lv J, Li R, Li P, Wang B. Treatment adherence among sputum smear-positive pulmonary tuberculosis patients in Xinjiang, China: a prospective study. RSC Adv 2018; 8:8983-8989. [PMID: 35539878 PMCID: PMC9078584 DOI: 10.1039/c7ra11820a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/01/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Despite great effort to control tuberculosis (TB), low treatment adherence threatens the success of drug therapy, increases the risk of TB transmission, and leads to the development of drug resistance. The present study assessed anti-TB treatment adherence in sputum smear-positive TB patients and examined the risk factors for poor patient adherence to identify targets for intervention. Methods: We monitored and followed up TB patients who were diagnosed between July 2014 and June 2015 in Xinjiang, China. A total of 8289 sputum smear-positive TB patients were included in this study. All patients registered their information during the first hospital visit or with the Centers for Disease Control, had regular follow-up visits, and accepted the anti-TB treatment. Insufficient re-examination adherence was defined as undergoing fewer than the recommended three sputum smear examinations during the treatment course. Results: Among 8289 patients, 3827 men (84.4% of male patients) and 3220 women (85.7% of female patients) had good adherence during treatment follow-up. 1242 patients (15.0%) did not complete regular follow-up. 332 (4.0%) patients lost contact. An adjusted logistic regression model showed that ethnicity, household address, treatment classification, patient source, and the actual management were significantly associated with non-adherence. Conclusion: The Xinjiang TB epidemic situation remains grim. Smear-positive patients had a higher proportion of non-adherence, which increased treatment difficulties and the risk of death from TB. Relevant medical departments should strengthen their supervision and interventions during the TB treatment process to improve patient adherence to anti-TB treatment. Background: Despite great effort to control tuberculosis (TB), low treatment adherence threatens the success of drug therapy, increases the risk of TB transmission, and leads to the development of drug resistance.![]()
Collapse
Affiliation(s)
- Xinji Gong
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Yuehua Li
- Wuhan City Pulmonary Hospital (Wuhan Tuberculosis Control Institute) Wu Han China
| | - Jing Wang
- Department of Geriatrics, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Gang Wu
- Wuhan City Pulmonary Hospital (Wuhan Tuberculosis Control Institute) Wu Han China
| | - Ayinuer Mohemaiti
- Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention Urumqi China
| | - Qimanguli Wushouer
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Lidan Yao
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Jianghua Lv
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Rongrong Li
- Department of Nutrition, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Pengfei Li
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| | - Buqing Wang
- Department of Respiratory Diseases, The First Affiliated Hospital of Xinjiang Medical University Urumqi China
| |
Collapse
|
17
|
Tang P, Wang X, Shen X, Shi M, Zhu X, Yu X, Liu J, Ling C, Wu M. Use of DNA microarray chips for the rapid detection of Mycobacterium tuberculosis resistance to rifampicin and isoniazid. Exp Ther Med 2017; 13:2332-2338. [PMID: 28565846 PMCID: PMC5443298 DOI: 10.3892/etm.2017.4250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/20/2017] [Indexed: 02/07/2023] Open
Abstract
The objective of the present study was to evaluate the potential development of DNA microarray chips to detect rifampicin (RFP) and isoniazid (INH) resistance in Mycobacterium tuberculosis (MTB), using samples from clinical tuberculosis (TB) patients in Soochow City, China. The sputum samples of 42 patients with TB in the Affiliated Hospital of Infectious Diseases of Soochow University (Soochow, China) were collected. The conventional Lowenstein-Jensen culture medium (Gold Standard) was used to assess drug sensitivity using the absolute concentration method. GeeDom MTB drug detection kits were also used to create a DNA microarray chip and examine the RFP-resistance associated gene mutation points rpoB-RRDR 511, 513, 516, 526, 531 and 533, and the INH-resistance associated gene mutation points katG315 and inhA-15 of the sputum samples. Compared with the results from the absolute concentration method, the susceptibility and specificity of RFP sensitivity detected by the DNA microarray chip were 92.8 and 93.8%, respectively. The susceptibility and specificity of INH sensitivity detected were 66.7 and 81%, respectively. The rpoB-RRDR 526, 531 mutations were the primary causes of MTB RFP resistance and the katG315 mutation was the primary cause of INH resistance. The detection of rpoB and katG gene mutation points by a DNA microarray chip may be used as a rapid, accurate and bulk clinical detection method for RFP and INH resistance in MTB. This is very valuable for the control of TB epidemics.
Collapse
Affiliation(s)
- Peijun Tang
- Department of Respiration, The First Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215007, P.R. China.,Department of Tuberculosis, The Affiliated Infectious Hospital of Soochow University, The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu 215007, P.R. China
| | - Xiafang Wang
- Department of Tuberculosis, The Affiliated Infectious Hospital of Soochow University, The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu 215007, P.R. China
| | - Xinghua Shen
- Department of Respiration, The First Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215007, P.R. China.,Department of Tuberculosis, The Affiliated Infectious Hospital of Soochow University, The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu 215007, P.R. China
| | - Meihua Shi
- Department of Tuberculosis, The Affiliated Infectious Hospital of Soochow University, The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu 215007, P.R. China
| | - Xuefeng Zhu
- Department of Tuberculosis, The Affiliated Infectious Hospital of Soochow University, The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu 215007, P.R. China
| | - Xin Yu
- Department of Tuberculosis, The Affiliated Infectious Hospital of Soochow University, The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu 215007, P.R. China
| | - Jia Liu
- Department of Tuberculosis, The Affiliated Infectious Hospital of Soochow University, The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu 215007, P.R. China
| | - Chunhua Ling
- Department of Respiration, The First Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215007, P.R. China
| | - Meiying Wu
- Department of Tuberculosis, The Affiliated Infectious Hospital of Soochow University, The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu 215007, P.R. China
| |
Collapse
|