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Etiological analysis and epidemiological significance of plague in Qinghai, 1980-2011

Jian-guo YANG ; Juan JIN ; Pei-song YOU ; Hui XIE ; Cun-xiang LI ; Jian HE ; Lin-de MA ; Hao-ming XIONG ; qiang ZHANG ; Fu-zhang TIAN ; Rui-xia DAI

China Tropical Medicine.2022;22(12):1109-. doi:10.13604/j.cnki.46-1064/r.2022.12.01

Abstract: Objective　To analyze the pathogenic characteristics and epidemiological significance of human plague related strains in Qinghai Province in recent 30 years, so as to provide scientific basis for on-the-spot disposal and prevention and control measures of plague outbreak in Qinghai Province. Methods　A total of 35 strains of Yersinia pestis isolated from 29 typical human plague outbreaks in Qinghai Province from 1980 to 2011 were selected and studied by biochemical fermentation experiments. Virulence factors detection of Fraction 1 antigen (Fra1), virulence antigen (VW), pigmentation (Pgm) and Yersinia pestis Ⅰ (PstⅠ), determinants and genotyping of differential regions (DFRs) were used to study the pathogenic characteristics. At the same time, according to the epidemic situation of human and animal plague in Qinghai Province in recent years, the current situation of plague prevention and control and epidemic characteristics were analyzed. Results　The biotypes of 35 strains of Yersinia pestis were classical, and the biotypes of 29 strains (82.86%) were of Qinghai-Tibet Plateau type, mainly distributed in southern Qinghai and around lake areas, 2 strains (5.71%) belonged to Qilian Mountains type, mainly distributed in Qilian mountains, and 6 genotypes were identified by DFR. Among them, 16 were type 5, 12 were type 8, 2 were type 10, 1 was type 36, 3 were type 30 and 1 was type 1b, the strains of type 5 and 1b were mainly distributed around the lake and the southern foot of Qilian Mountains, while the strains of type 8, 10, 36 and 30 were mainly distributed in the southern part of Qinghai. Conclusions　The pathogen of Yersinia pestis in Qinghai Plateau has complex biochemical types, the epidemic situation among animals is continuous year after year, the situation of prevention and control is serious, the occurrence and prevalence of plague seriously endanger people's health and social development, so it is necessary to do a solid job in the prevention and control of plague to ensure the safety of people's lives.

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The prevalence and influencing factors of common chronic diseases among residents in Aheqi County, Xinjiang

Abudireyimu ALIMIRE ; Yin-xia SU ; Cong-hui HU ; Yuan-yuan LI ; Hua YAO

China Tropical Medicine.2022;22(12):1113-. doi:10.13604/j.cnki.46-1064/r.2022.12.02

Abstract: Objective To understand the prevalence and influencing factors of major chronic diseases among Kirgiz residents in Aheqi County, Xinjiang, and to provide theoretical basis for the prevention and control of chronic diseases in this area. Methods　The data of residents in Aheqi County, Kizilsu Kirgiz Autonomous Prefecture, Xinjiang in 2020 for health checkup were selected, and the permanent residents of Kirgiz nationality aged ≥18 were selected as the survey objects, and the prevalence of major chronic diseases and their influencing factors were analyzed by Logistic regression model. Results　A total of 21 935 patients were enrolled, and 10 602 patients suffered from chronic diseases with a prevalence rate of 48.33%, including 4 929 cases of hypertension with a prevalence rate of 22.47%, 4 238 cases of obesity with a prevalence rate of 19.32%, 3 610 cases of dyslipidemia with a prevalence rate of 16.46%, 1 632 cases of anemia with a prevalence of 7.44%, and 1 236 cases of type 2 diabetes with a prevalence of 5.63%. The prevalence of hypertension, obesity, dyslipidemia and type 2 diabetes increased with age, while the prevalence of anemia decreased with age (P<0.01). The prevalence of hypertension dyslipidemia and type 2 diabetes was higher in males than in females, and the prevalence of obesity and anemia was higher in females than in males, with statistical significance (P<0.01). Logistic regression analysis showed that 30-<40 years old (OR=1.836, 95%CI: 1.565-2.034), 40-<50 years old (OR=2.916, 95%CI: 2.613-3.255), 50-<60 years old (OR=5.244, 95%CI: 4.651-5.913), 60 years old and above (OR=10.866, 95%CI: 9.533-12.385), government personnel (OR=1.789, 95%CI: 1.405~2.279), professional and technical personnel (OR=1.774, 95%CI:1.372-2.295), the office staff (OR=1.923, 95%CI: 1.418-2.607) occasional alcohol consumption (OR=1.157, 95%CI: 1.055-1.270) and occasional exercise (OR=1.498, 95%CI: 1.238-1.812) were risk factors for chronic disease. Conclusion　The prevalence of chronic diseases among residents in Aheqi County of Xinjiang is at a low level. Local health institutions have strengthened health education and publicity on multiple chronic diseases and the prevention and control of anemia among young and middle-aged women.

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Clinical significance of autoantibody and liver function test in patients with chronic hepatitis B combined with autoimmune liver disease

Fen ZHOU ; Meng-kui HAN ; Ping XU ; Jin LI

China Tropical Medicine.2022;22(12):1119-. doi:10.13604/j.cnki.46-1064/r.2022.12.03

Abstract:Objective To detect the expression of hepatic function indices and autoantibodies in patients with chronic hepatitis B patients, patients with autoimmune liver disease and patients with chronic hepatitis B combined with autoimmune liver disease, and to evaluate the clinical significance of autoantibodies and hepatic function indexes in the early diagnosis of chronic hepatitis B combined with autoimmune liver disease.Methods A total of 109 healthy controls (HC), 72 patients with chronic hepatitis B (CHB), 74 patients with autoimmune liver disease (AILD), and 24 patients with chronic hepatitis B combined with autoimmune liver disease (CHB+AILD) in the Fifth People’s Hospital of Suzhou from 2013 to 2021 were enrolled in this study. Basic information and the value of admission hepatic function indexes and autoantibodies were collected for all enrolled samples, while no autoantibody test was performed for healthy volunteers. All data were processed using GraphPad Prism and SPSS software.Results There were no significant differences in age and gender among the four groups. The detection rates of anti-mitochondrial antibody M2 (AMA-M2) and anti-soluble acidic phosphorylated nuclear protein antibody (anti-SP100 antibodies) in CHB+AILD group [29.2%(7/24), 17.4%(4/23)] were significantly higher than those in CHB group [5.1%(3/59), 0(0/59)], suggesting that the detection of these two autoantibodies is helpful to the differential diagnosis of CHB and CHB+AILD. In addition, eight hepatic function indexes displayed significant differences among the four groups. The levels of total bilirubin and direct bilirubin in CHB+AILD group were significantly higher than those in CHB and AILD groups, while the levels of total protein and albumin were significantly lower than those in CHB and AILD groups. Alkaline phosphatase and glutamyltranspeptidase in AILD group and CHB+AILD group were significantly higher than those in CHB group. The logistic regression analysis showed that total bilirubin, direct bilirubin, albumin, alanine aminotransferase and alkaline phosphatase could form a promising prediction model, which was useful for clinicians in the differential diagnosis of CHB and CHB+AILD (area under the curve, AUC=0.902).Conclusion The combination of autoantibody and hepatic function index detection can be helpful for clinicians in the differential diagnosis of CHB, AILD and CHB+AILD, thus contributing to the early and correct diagnosis of CHB+AILD and providing theoretical basis for patients to obtain reasonable treatment and clinical cure earlier.

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Effect of Clonorchis sinensis infection on the coagulation indexes of patients with chronic hepatitis B

Yang WANG ; Jia-lan LIN ; Hui LUO ; Hui-min DONG

China Tropical Medicine.2022;22(12):1125-. doi:10.13604/j.cnki.46-1064/r.2022.12.04

Abstract: Objective To analyze the changes of coagulation indicators in patients with hepatitis B complicated with Clonorchis sinensis (C. Sinensis), and provide reference value for diagnosis, drug using and prognosis monitoring. Methods　The patient samples were collected from the Third Affiliated Hospital of Sun Yat-sen University from June 2018 to February 2022 and divided into six groups. They were 40 healthy patients, 47 patients with simple chronic hepatitis B, 47 patients with post-hepatitis B liver cirrhosis, 40 patients with C. Sinensis mono-infection, 30 patients with chronic hepatitis B patients co-infected with C. Sinensis and 27 patients with post-hepatitis B liver cirrhosis patients coinfected with C. Sinensis. Four coagulation indexes, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB), were detected and compared among the groups. Results Compared with the healthy group, C. Sinensis mono-infection group had higher level of FIB and delayed PT, APTT; chronic hepatitis B group and chronic hepatitis B patients co-infected with C. Sinensis group had delayed PT, APTT, TT and significant lower FIB, these differences were statistically significant (all P<0.05). Compared with simple chronic hepatitis B group, post-hepatitis B liver cirrhosis and chronic hepatitis B patients co-infected with C. Sinensis had significant delayed PT, APTT, TT and lower FIB (all P<0.05). Compared with the post-hepatitis B liver cirrhosis and chronic hepatitis B patients co-infected with C. Sinensis, post-hepatitis B liver cirrhosis patients coinfected with C. Sinensis group had significant delayed PT, APTT, TT and lower FIB (all P<0.05). Conclusions The coinfection of C. Sinensis will further aggravate the coagulation dysfunction of HBV patients, leading to poor treatment and prognosis. HBV patients will have worse coagulation function in the process to post-hepatitis B liver cirrhosis; Therefore, it is important to pay attention to C. Sinensis co-infection when treating HBV patients, so that further guidance on clinical use and monitoring of prognosis can be provided.

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Detection of peripheral blood T lymphocyte subpopulations among patients positive for both hepatitis B virus surface antigen and surface antibody

Dan CHEN ; Qiu-bo WANG ; Dan-dan SHEN

China Tropical Medicine.2022;22(12):1130-. doi:10.13604/j.cnki.46-1064/r.2022.12.05

Abstract: Objective　To investigate the frequency of peripheral blood T cells among patients positive for both hepatitis B virus surface antigen (HBsAg) and surface antibody (HBsAb). Methods　 Thirty six patients with co-existence of HBsAg and HBsAb diagnosed were enrolled as the experimental group, who were admitted by Shanghai tenth people's hospital and Wuxi 9th people's hospital from 2014 to 2020. while 40 patients tested positive for HBsAg and negative for HBsAb served as controls, who were admitted by Wuxi 9th people's hospital. Flow cytometry was used to detect and compare the proportions of peripheral blood CD3+, CD4+ and CD8+ T cells between the experimental and control groups. In addition, the associations of serum HBsAb level with peripheral blood T cell proportions, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were examined among chronic hepatitis B patients with co-existence of HBsAg and HBsAb using Pearson correlation analysis. Results　The median age, gender distribution, mean ALT and AST concentrations, proportion of HBV DNA viral load>103 copies/mL, seroprevalence of HBV E antigen (HBeAg), seroprevalence of HBV E antibody (HBeAb), seroprevalence of HBV core antibody (HBcAb) were comparable between the experimental and control groups, and there were no significant difference in them (P>0.05). There were no significant difference between the experimental and control groups in terms of CD3+ T cell proportion [(71.83±1.50)% vs (72.75±1.47)%; t=0.66, P>0.05], CD4+ T cell proportion [(36.81±1.53)% vs (39.88±1.57)%; t=1.43, P>0.05] and CD8+ T cell proportion [(33.17±2.04)% vs (32.40±1.75)%; t=0.77, P>0.05]. Pearson correlation analysis revealed that the serum HBsAb level did not significantly correlate with peripheral blood CD3+ (r=0.026, P=0.65), CD4+ (r=‒0.08, P=0.16) and CD8+ T cell proportions (r=0.09, P=0.24), CD4+/CD8+ T proportion (r=‒0.005, P=0.35), serum ALT (r=0.04, P=0.56) and AST levels (r=0.002, P=0.69) among chronic hepatitis B patients with co-existence of HBsAg and HBsAb. Conclusions　There are no significant differences between HBsAg+/HBsAb+ and HBsAg+/HBsAb- CHB patients in terms of peripheral blood CD3+, CD4+ and CD8+ T cell proportions.

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A multicenter analysis of bacteria distribution and antimicrobial resistance of bloodstream infection in Yunnan, 2017-2021

Hong-juan ZHANG ; Yun-min XU ; Xiao-xue DONG ; Rui ZHENG ; Bao-jun REN ; Bin SHAN

China Tropical Medicine.2022;22(12):1135-. doi:10.13604/j.cnki.46-1064/r.2022.12.06

Abstract: Objective　To analyze the distribution and drug resistance evolution characteristics of pathogenic bacteria of bloodstream infection in nine tertiary hospitals in Yunnan Province from 2017 to 2021, so as to provide reliable basis for rational selection of antibiotics in clinic. Methods Using the drug sensitive paper method or instrument method, the bacteria identification and drug sensitivity test were carried out in nine tertiary hospitals in different regions according to the unified technical scheme. The results were judged according to the Clinical and Laboratory Standards Institute (CLSI) breakpoint standard in 2021, and use WHONET5.6 for data statistical analysis. Results A total of 12 003 strains of pathogenic bacteria were isolated from bloodstream infection samples in the past five years, including 7 442 strains of Gram-negative bacteria (62.0%) and 4562 strains of Gram-positive bacteria (38.0%), with an increasing trend in the number of isolated strains; of these, 163 strains (1.4%) were isolated from outpatients and 11 840 strains (98.6%) were isolated from inpatients. The top three gram-negative bacteria were Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii, of which 309 strains (4.2%) were carbapenem-resistant Klebsiella pneumoniae (CR-KPN), 29 strains (0.4%) carbapenem-resistant Escherichia coli and 19 strains (0.3%) carbapenem-resistant Enterobacter cloacae, and the number of CR-KPN was on the rise year by year. The top three Gram-positive bacteria were coagulase-negative staphylococci, Staphylococcus aureus and Enterococcus faecium, of which methicillin-resistant Staphylococcus aureus (MRSA) was detected for 213 strains, accounting for 27.7%, and decreased from 40.0% in 2017 to 23.4% in 2021, showing a downward trend year by year. No vancomycin-resistant staphylococci and enterococci were found. Conclusions The detection and composition of bloodstream infection pathogenic bacteria in multicenter have not changed much in the past five years, but each hospital has its own characteristics. The number of carbapenem resistant Enterobacteriaceae increased year by year, which should be paid more attention.

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Analysis of surveillance results of Aedes albopictus in Hainan, 2017-2021

Ying LIU ; Ding-wei SUN ; Qun WU ; Shan-gan LI ; Pu-yu LIU ; Xue-xia ZENG

China Tropical Medicine.2022;22(12):1142-. doi:10.13604/j.cnki.46-1064/r.2022.12.07

Abstract: Objective　To understand the density changes and seasonal fluctuation of larvae and adults of Aedes albopictus in Hainan Province from 2017 to 2021, and to provide a scientific basis for the prevention and control of dengue fever and other vector-borne diseases in Hainan Province. Methods　The Breteau index method was used to monitor the larvae of Aedes mosquitoes, and the breeding sites of all small indoor and outdoor water containers and their larvae was checked and recorded. The adult mosquitoes were monitored by double lamination and light trap. Results　A total of 1 962 adult female Aedes albopictus mosquitoes were captured in Hainan Province from 2017 to 2021, accounting for 2.17% of the total captured mosquitoes. There were significant differences in mosquito species composition in different habitats in different years (χ2=312.258, P<0.01). In 2017, the density of mosquitoes in livestock sheds was the highest (9.71 per lamp·night), but the composition ratio of Aedes albopictus was the lowest (1.29%). In 2020, the mosquito density in hospitals was the lowest (2.22 mosquitoes per lamp·night), and in 2019, the proportion of Aedes albopictus in residential areas and hospitals was the highest (3.27% on average).The mosquito density in different habitats was the lowest in 2020. The proportion of Aedes albopictus in residential areas and livestock sheds showed an increasing trend from 2017 to 2021, while the proportion of other habitats showed significant fluctuations. The proportion of Aedes albopictus in hospitals showed an obvious decreasing trend in 2020. From 2017 to 2021, the average mosquito density was 5.97, 4.26, 3.82, 3.39 and 3.68 mosquitoes per lamp·night, respectively, showing a decreasing trend year by year except 2021. Except for 2019, the lure index also showed a decreasing trend, with an average value of 1.5/(hour·net), showing a decreasing trend year by year. From 2017 to 2021, the annual average density of Aedes albopictus in Hainan Province was 0.09 mosquitoes per lamp·night, showing obvious seasonal fluctuation. The Breteau index showed a slow decline from 2017 to 2021, and its annual peak was between June and August, which was 1-2 months later than the peak of adult mosquito density. Conclusions　The population density of Aedes albopictus in Hainan shows obvious seasonal characteristics. Mosquito control activities should be carried out according to the seasonal characteristics of mosquitoes to reduce the risk of dengue fever and other infectious diseases.

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Analysis of genetic carrier of neonatal deafness in Hainan

Xia-lin FAN ; Li-chun FAN ; Chui-can HUANG ; Wei-jia WU ; Xi-jing WU

China Tropical Medicine.2022;22(12):1147-. doi:10.13604/j.cnki.46-1064/r.2022.12.08

Abstract: Objective　To explore the carrying status of four common deafness genes and mutations on 10 loci in newborns in Hainan, and to analyze the molecular epidemiological characteristics of deafness genes and their loci, so as to provide scientific basis for formulating neonatal deafness gene screening strategy and promoting children's hearing health in Hainan. Methods　Newborns born in Hainan from January 2020 to December 2021 were selected as the research objects. The demographic characteristics of the research objects were collected. At the same time, the plantar blood of newborns was collected, and multiplex PCR amplification and directed hybridization combined with high-throughput sequencing technology were applied to detect 10 mutation loci on 4 common deafness genes. T-test or chi square test was used to process the data. Results　A total of 7 124 newborns were included in the study through informed consent, 219 cases of deafness gene mutation were detected with the detection rate of deafness gene of 3.07%. The detection rates of GJB2, SLC26A4, MT-RNR1 and GJB3 were 1.56% (111/7 124), 1.18% (84/7 124), 0.21% (15/7 124) and 0.11% (8/7 124) respectively. Among the 10 loci of the four genes, the positive detection rate of c.235delC locus of GJB2 was the highest, which was 1.38% (98/7 124), followed by c.919-2A>G of SLC26A4 (0.87%, 62/7 124); 2.63% (113/4 289) of the newborns who passed the preliminary hearing screening still carried the deafness gene; in terms of gene type, the detection rate of GJB2 gene in newborns who failed the hearing screening was higher than that in newborns who passed the hearing screening [2.23% (63/7 124) vs 1.12% (48/7 124)，P<0.01]; in terms of gene loci, the detection rate of c.235delC locus in newborns who failed hearing screening was higher than that in newborns who passed hearing screening [2.09% (59/7 124) vs 0.91% (39/7 124)，P<0.01]. Conclusion　The most common deafness genes types in Hainan were GJB2 and SLC26A4; The most common gene mutation sites were c.235delC and c.919-2A>G; 2.63% of the newborns who passed the preliminary hearing screening still carried the deafness gene, among which the high-risk newborns with MT-RNR1 and GJB3 genes were found. Therefore, hearing screening should be combined with deafness gene screening to improve the detection rate of children at high risk of hearing loss.

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Relationship between the expression of peripheral blood stimulating molecules CD80, CD86 and the therapeutic effects of children with severe hand, foot, and mouth dise

Xiang ZHOU ; Jian-xin CAI ; Fei WANG

China Tropical Medicine.2022;22(12):1160-. doi:10.13604/j.cnki.46-1064/r.2022.12.10

Abstract: Objective　To observe the expression of peripheral blood stimulating molecules CD80 and CD86 in children with severe hand, foot, and mouth disease (HFMD), and to analyze the relationship between them and the therapeutic effects of children. Methods　The clinical data of 252 children with severe HFMD treated in Wuhan Hospital of Traditional Chinese Medicine from March 2017 to March 2021 were collected retrospectively. All children were treated with standardized treatment and the therapeutic effects was evaluated. The baseline data and laboratory test results of children were recorded, and the positive rates of CD80 and CD86 cells in peripheral blood were detected by flow cytometry. Logistic regression was used to analyze the relationship between the above indexes and the therapeutic effects of children. The receiver operating curve (ROC) was drawn to evaluate the value of the above indicators in predicting the therapeutic effects of children. Results　After standardized treatment, 48 children were ineffective, and 204 children were effective; the levels of serum CD80 [(2.28±0.84)% vs (2.12±0.33 )%] and CD86 [(3.35±0.96)% vs (2.23±0.41)%] in children were significantly lower than those at admission (t=2.851, 16.991; P<0.05). The levels of blood lactic acid, serum C-reactive protein (CRP), matrix metalloproteinase-9 (MMP-9), CD80 and CD86 at admission in the ineffective group were significantly higher than those of the effective group (P<0.05). Logistic regression analysis showed that the overexpression of serum CRP (OR=10.929), MMP-9 (OR=1.926), CD80 (OR=3.943) and CD86 (OR=1.947) at admission might be the risk factors of ineffective (all P<0.05). The results of the goodness of fit test for the model showed that, the goodness of fit was high (χ2=6.245, P=0.620); the model collinearity results showed that the variance inflation factors (VIF) values of each variable were <2, and there was no collinearity among the main indicators; the results of the individual independence test for the model showed that Durbin-Watson statistics (D-W)=0.279 and there was poor mutual independence among main indicators. ROC curve analysis showed that the area under the curve(AUC) of serum CD80 at admission in predicting the therapeutic effects of children was 0.762, the cut-off value was 2.390%, and the specificity, sensitivity and Youden index were 0.598, 0792 and 0.390 respectively; the AUC predicted by CD86 was 0.739, the cut-off value was 3.280%, and the specificity, sensitivity and Youden index were 0.510, 0.896 and 0.406 respectively; the AUC by combined prediction was 0.823, and the specificity, sensitivity and Youden index were 0.696, 0.833 and 0.529 respectively. Conclusions　Peripheral blood stimulating molecules CD80 and CD86 are involved in the progression of HFMD. Their overexpression may suggest a high risk of treatment ineffectiveness in children with severe HFMD. Early dynamic monitoring of the expression of serum CD80 and CD86 has a certain predictive value for the therapeutic effect of children.

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Effect of live attenuated varicella vaccine on tuberculin skin test

Ting-ting LI ; Xiao-wen SHEN ; Zhu-ping XU ; Qi ZHANG ; Chao-jun QIAN ; Hong-bo QU

China Tropical Medicine.2022;22(12):1165-. doi:10.13604/j.cnki.46-1064/r.2022.12.11

Abstract: Objective　This paper aims to explore the effect of live attenuated varicella vaccine on the sensitivity of tuberculin skin test(TST), and to provide reference for tuberculin skin test in the future. Methods　TST and emergency varicella vaccine were administered to students in grade one of a high school in Wuxi, Jiangsu province, who had both TB and varicella cases. Independent-samples t test was used to analyze the mean diameter of induration of TST in day 0, day 83 and day 195. The retrospective cohort study was used to analyze the effect of live attenuated varicella vaccine on TST. 　　Results　The mean induration diameter of 45 students who participated in three TST tests on day 0, day 83 and day 195 were analyzed by independent sample t test. On day 0, there was a difference in the mean diameter of TST induration between the unvaccinated and vaccinated groups(1.630±2.837 vs 5.818±4.530) (t=-3.692, P=0.001). On day 83, there was no difference in the mean diameter of TST induration between the two groups(0.001±0.001 vs 0.114±0.533) (t=-1.000, P=0.329). On day 195, there was a difference in the mean diameter of TST induration between the two groups(1.913±3.774 vs 5.023±5.126) (t=-2.309, P=0.026). Moreover, the retrospective cohort study showed that the mean diameter of TST induration changed more significantly after inoculation with varicella vaccine, RR=6.071, 95%CI (1.667-22.116), P<0.05; After inoculation with varicella vaccine, the mean diameter of TST test did not change significantly from day 0 to day 195 with no statistical significance RR=3.474, 95%CI (0.333-36.240), P>0.05. Conclusions　Live attenuated varicella vaccine may temporarily affect the sensitivity of tuberculin skin test.

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