The Analysis of the Infectious Characteristics of the Pulmonary Tuberculosis and the Treatment Outcomein Eastern Taiwan

Autor: Han-Yu Huang, 黃寒裕
Rok vydání: 2011
Druh dokumentu: 學位論文 ; thesis
Popis: 99
Background: We have known that the infection and protection of tuberculosis (TB) are influenced by the cluster factor, the host immunity, and the strains of Mycobacterium tuberculosis. The study used the molecular biology technique and the traditional epidemiologic method to explore the above issues in eastern Taiwan. Methods: The first part, we used the active chest X-ray screening for TB and the passive symptom screening by elevating the alert for TB of the primary physician to evaluate the two large chronic psychiatric hospitals for 2 years. The purpose was to find the TB notified rate in the two psychiatric hospitals. TB isolates would be sent to do the genotyping by IS6110 RFLP and spoligotyping methods. We used chart review to trace the possible epidemiologic linkage and compared the different infection control policies and other factors which would influence the nosocomial transmission of TB. The second part, we collected the blood of the TB patients and healthy volunteers. Using the gene sequencing method, we evaluated the distribution of the genetic polymorphism of TLR4 and NFKB1 in the two groups. In addition, we compared the severity of chest X-ray with the genetic polymorphism. The third part, by using PCR-RFLP method, we evaluated the distribution of the genetic polymorphism of vitamin D receptor and the plasma concentration of vitamin D. In addition, we compared the severity of chest X-ray with the genetic polymorphism and the plasma concentration of vitamin D. The fourth part, patients were enrolled at Tzu Chi General Hospital (TCGH) suspected of having active pulmonary TB from October 2004 to September 2005 (non-DOTS generation) and August 2008 to December 2009 (DOTS generation). The final diagnosis was confirmed by sputum cultures. Charts were reviewed to obtain the clinical information. A modified multiplex PCR method was developed to distinguish Beijing, non-Beijing strains and mixed infection directly using the sputum of patients. In addition to comparing the incidence rate of infection with Beijing, non-Beijing, and mixed strains, and the drug susceptibility pattern, we evaluated the treatment outcome of the three groups. The univariate and multivariate analyses were used to find the factors influencing treatment outcome. Results: The first part, 30 TB patients in hospital A and 8 in hospital B were diagnosed. The notified disease rate in hospital A was 619 per 100,000 population per year and in hospital B 203. Seventeen patients (56.7%) in hospital A had six cluster pattern strains, and none did in hospital B, which highlighted the importance of thorough isolation of TB suspects. The second part, we analyzed 126 samples in TB patients and healthy volunteers and found that there was no polymorphism of Asp299Gly and Thr399Ile in TLR4. The distribution of the genetic polymorphism of NFKB1 was not different in both groups. In addition, the polymorphism of NFKB1 was not related to the severity of chest X-ray, either. The third part, the distribution of the genetic polymorphism of vitamin D receptor was not different in TB patients and healthy volunteers. But there was higher plasma vitamin D concentration in TB patients. In addition, the polymorphism of vitamin D receptor and the plasma vitamin D concentration were not related to the severity of chest X-ray, either. The fourth part, of the 385 patients, 45.2% were infected with a Beijing strain, 42.1% were infected with a non-Beijing strain, and 12.7% were infected with mixed strains. The mixed infection group had the highest non-MDR rate (12.2%); however, Beijing strains had the highest multidrug resistance rate (18.4%). The mixed infection group had the less successfully treated rate (65.3%) than that of the non-Beijing strain group. By multivariate analysis, the gender, age group, TB treatment history, different TB strains, drug susceptibility, and accepting DOTS or not were the independent factors of influencing treatment outcomes. Conclusions: In terms of the cluster factors, the TB notified disease rate in the chronic large psychiatric hospital is much higher than that of the average rate of Taiwan. Thorough isolation could decrease the nosocomial transmission of TB in the large chronic psychiatric hospitals. About the host factors, the genetic polymorphism of NFKB1 and vitamin D receptor in the population of the eastern Taiwan is not related to the TB susceptibility. In addition, the polymorphism of NFKB1 and vitamin D receptor is not related to the severity of chest X-ray, either. To the TB strains, patients infected with mixed strains consist of 12.7% in eastern Taiwan. The mixed infection group has the intermediate drug resistant pattern, and the intermediate outcome of successfully treated rate. We find that female, young age group, no TB treatment history, non-Beijing strain group, pansusceptible drug sensitivity of M. tuberculosis, and accepting DOTS could predict better treatment outcome.
Databáze: Networked Digital Library of Theses & Dissertations
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