Progress in tuberculosis (TB) control has long been constrained by a limited understanding of the continuous disease spectrum. Traditionally, TB has been simplistically dichotomized into latent infection and active disease; however, recent research has provided compelling evidence that the disease actually constitutes a spectrum encompassing continuous changes in bacterial metabolic activity and host immune responses, thereby establishing subclinical tuberculosis as a crucial clinical state within this continuum. Subclinical TB is characterized by the absence of typical clinical symptoms but the presence of bacteriological or radiological evidence, accounting for 36–80

Background: The incidence of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) complicated by chronic pulmonary aspergillosis (CPA) has been increasing. CPA is known to be associated with complex treatment regimens and a poor prognosis. However, data from mainland China remain scarce. This single-center retrospective study aimed to evaluate the clinical characteristics, risk factors, and prognoses of patients with concurrent CPA and NTM-PD. Methods: We conducted a retrospective review of the medical records of 248 patients diagnosed with NTM-PD. Risk factors for CPA were analyzed via multiple logistic regression, followed by survival analysis. Results: Among the 248 patients with NTM-PD, 66 (26.6%) were diagnosed with CPA. Independent risk factors for NTM-PD and CPA coinfection included male sex (OR 2.13, 95% CI: 1.03-4.47), dyspnea (OR 27.9, 95% CI: 4.24-570), cavity (OR 5.95, 95% CI: 2.76-13.9), use of oral corticosteroids (OR 4.28, 95% CI: 1.13-16.6), and interstitial lung disease (OR 15.5, 95% CI: 1.89-361). The wide confidence intervals for some risk factors reflect limited precision. The Kaplan-Meier survival curves indicated a significant divergence between the NTM-PD group and the NTM-PD with CPA group (log-rank test, p = 0.00039). However, the adjusted hazard ratio was not statistically significant (HR 2.01, 95% CI: 0.66-6.12, p = 0.217). Conclusions: In patients with NTM-PD, the presence of concurrent CPA was associated with higher unadjusted mortality. Clinicians should maintain a high index of suspicion for CPA to ensure prompt diagnosis and treatment, particularly in high-risk individuals.

This study aimed to develop and validate stratified machine learning models for early prediction of anti-tuberculosis drug-induced liver injury (ATB-DILI) risk, targeting both a general tuberculosis (TB) treatment population and a high-risk subgroup with chronic hepatitis B (CHB) co-infection, based on real-world clinical data. A single-center retrospective cohort study was conducted using data from 11,361 TB patients (3,787 ATB-DILI cases and 7,574 controls) and a CHB subgroup of 1,017 patients (339 cases and 678 controls) after propensity score matching. Ten machine learning algorithms, including Logistic Regression, Random Forest (RF), and XGBoost, were applied. Models were trained and validated using a 1:1 split and 10-fold cross-validation. Performance was evaluated using AUC, accuracy, sensitivity, specificity, precision, and F1-score. Model interpretability was enhanced using SHapley Additive exPlanations (SHAP). In the overall population, ensemble methods such as RF and XGBoost achieved AUCs of 0.960 and 0.954, respectively, on the validation set. In the CHB subgroup, RF and XGBoost performed even better, with AUCs of 0.994. Key predictors in the general population included ALT, eosinophil count, AST, and procalcitonin, while in the CHB subgroup, total bile acid, procalcitonin, ALP, and prealbumin were most influential. SHAP analysis revealed non-linear relationships between features and ATB-DILI risk, aligning with clinical knowledge. Stratified machine learning models, particularly ensemble methods, demonstrated excellent performance in predicting ATB-DILI risk and highlighted distinct injury mechanisms between general and CHB co-infected TB patients. This approach offers a clinically interpretable and accurate tool for early warning of ATB-DILI, supporting personalized risk assessment and management.

Six months of drug treatment is standard of care for drug-sensitive pulmonary tuberculosis (TB). Understanding the factors determining the length of treatment required for durable cure would allow individualization of treatment durations. We conducted a prospective, randomized, controlled noninferiority trial (PredictTB) of 4 versus 6 months of chemotherapy in patients with pulmonary TB in South Africa and China. Seven hundred and four participants with newly diagnosed, drug-sensitive TB were enrolled and stratified on the basis of radiographic disease characteristics assessed by FDG PET/CT imaging. Participants with less extensive disease (n = 273) were randomly assigned at week 16 to complete therapy after 4 months or continue receiving treatment for 6 months. This study was stopped early after an interim analysis revealed that patients assigned to the 4-month treatment arm had a higher risk of relapse. Among participants who received 4 months of chemotherapy, 17 of 141 (12.1%) experienced TB-specific unfavorable outcomes compared with only 2 of 132 (1.5%) who completed 6 months of treatment. In the nonrandomized arm that included participants with more extensive disease, only 8 of 248 (3.2%) experienced unfavorable outcomes. Total lung cavity volume and lesion glycolysis at week 16 were associated with the risk of unfavorable outcomes. PET/CT imaging at TB recurrence showed that bacteriological relapses predominantly occurred in active cavities originally present at baseline. Subsequent post hoc automated segmentation of serial PET/CT scans combined with machine learning enabled the classification of participants according to their likelihood of relapse.

The guidelines for Mycobacterium abscessus pulmonary disease do not provide a clear approach to combination therapy. This study aims to assess the effectiveness of phase therapy (PT) containing clofazimine (CFZ) for patients with Mycobacterium abscessus pulmonary disease. This study was carried out at Beijing Chest Hospital, Capital Medical University. It included 24 confirmed cases of Mycobacterium abscessus pulmonary disease who were prospectively enrolled and treated with a CFZ-containing regimen. Additionally, 35 confirmed cases were retrospectively included for comparison. Baseline information of patients was collected. Patients were followed up for over a year. Minimal inhibitory concentration (MIC) testing was conducted on clinical isolates from patients to determine if there is a correlation between MIC values and sputum culture conversion. The retrospective patients achieved a 36.7

The Mycobacterium abscessus complex (MABC) is highly resistant to antibiotics, making the pulmonary disease it causes, known as MABC-PD, difficult to treat. Macrolide antibiotics are the main treatment for MABC-PD, but there is ongoing debate about whether to favor azithromycin (AZI) or clarithromycin (CLA). We compared how well AZI and CLA work against MABC and monitored the risk of developing resistance. MABC-PD patients were enrolled, and their primary isolates were collected. The minimum inhibitory concentrations (MICs) of CLA and AZI against these isolates over various incubation times were determined. The incidences of the acquired and inducible resistance of the isolates to both antibiotics were compared, and their association with culture conversion was monitored. The transcription levels of the erm(41) gene were quantified. A total of 61 MABC-PD patients who underwent a macrolide-containing treatment regimen were enrolled. The MICs of AZI against the MABC clinical isolates were found to be approximately four to eight times higher than those of CLA. Inducible macrolide resistance was observed in the subspecies Mycobacterium abscessus, which possessed the functional erm(41) gene. Inducible resistance to AZI happened more rapidly than to CLA, and the transcription of the erm(41) elevated significantly after prolonged exposure to macrolides. Patients infected with isolates with functional erm(41) gene or rrl mutation experienced lower rates of culture conversion compared to those without such mutations. Acquired and inducible resistance to macrolides significantly contributes to the treatment failures of MABC-PD. The in vitro sensitivity and the inducible resistance occurrence all favor CLA over AZI for MABC-PD treatment. IMPORTANCE:The Mycobacterium abscessus complex (MABC) is highly resistant to antibiotics, making Mycobacterial abscessus pulmonary disease (MAPD) difficult to treat. Macrolide antibiotics are the main treatment, but there is debate over whether azithromycin (AZI) or clarithromycin (CLA) is more effective. In our study of 61 MAPD patients, we compared the effectiveness of AZI and CLA while tracking resistance. We found that the minimum inhibitory concentrations (MICs) of AZI were four to eight times higher than those of CLA. Isolates with the functional erm(41) gene exhibited macrolide resistance, with AZI developing resistance faster than CLA. Patients with these resistant strains had lower rates of successful treatment. Overall, the in vitro sensitivity and the inducible resistance occurrence all favor CLA over AZI for MABC-PD treatment.

Introduction:Diagnosing tuberculosis (TB) in HIV-infected individuals presents significant challenges due to difficulties in obtaining specimens containing adequate quantities of Mycobacterium tuberculosis (Mtb). This study aimed to evaluate the diagnostic performance of the IP-10 mRNA assay independently and in combination with established diagnostic tests for Mtb detection. Methods:The study cohort comprised 111 HIV-infected individuals who presented with TB at Beijing Youan Hospital from 2022 to 2024. Participants were categorized into confirmed TB, probable TB, or non-TB groups according to the diagnostic criteria for tuberculosis (WS288-2017). The performance of the IP-10 mRNA release assay was evaluated by the STARD guidelines on blood samples collected after enrollment. Results:The IP-10 mRNA release assay demonstrated significantly higher sensitivity than interferon-γ release assays (IGRAs) and culture methods for confirming pulmonary tuberculosis (PTB) diagnosis while maintaining comparable specificity. Receiver operating characteristic (ROC) analysis revealed that the diagnostic performance of the IP-10 mRNA release assay used in parallel with Xpert MTB/RIF significantly exceeded that of the IP-10 mRNA release assay alone (0.731 vs. 0.687, P=0.02). Among HIV-infected individuals, the IP-10 mRNA release assay showed superior performance compared to IGRAs for diagnosing extrapulmonary tuberculosis. Conclusions:The IP-10 mRNA release assay exhibited excellent diagnostic performance and demonstrates substantial potential as an auxiliary tool for diagnosing TB in HIV-infected individuals. The combined application of IP-10.TB and Xpert MTB/RIF further enhance diagnostic efficacy.

Background: Tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) are major respiratory diseases contributing to high global morbidity and mortality. Recent studies suggest a potential bidirectional association between them; however, the overall evidence has not been systematically integrated. This study aims to comprehensively evaluate the bidirectional epidemiological association between TB and COPD through a systematic review and meta-analysis. Methods: We systematically searched observational studies published from database inception to 31 August 2025, in PubMed, Embase, Web of Science, and other databases. Data were extracted from studies examining the risk of COPD development in individuals with a history of TB and the risk of TB development in COPD patients. Pooled effect sizes were calculated using random-effects models, including pooled odds ratios (ORs) and prevalence rates, with assessments of heterogeneity and publication bias. Results: A total of 32 studies were included, involving over 670,000 participants. Meta-analysis revealed that individuals with a history of TB had a significantly increased risk of developing COPD (pooled OR = 2.46, 95% CI: 1.95–3.10). Similarly, COPD patients had a significantly elevated risk of developing TB (pooled OR = 2.21, 95% CI: 1.57–3.11). The pooled prevalence of COPD among TB patients was 15.95% (95% CI: 11.61–21.53), while the pooled prevalence of TB among COPD patients was 5.57% (95% CI: 2.24–13.18). Significant heterogeneity was observed, but no substantial publication bias was detected. Conclusions: A significant and robust bidirectional association exists between TB and COPD, with each being an important independent risk factor for the other. These findings underscore the necessity of integrated screening and comorbidity management for both diseases in clinical practice and public health strategies, particularly in high TB burden regions. Prospective studies are warranted to further elucidate causal mechanisms and evaluate interventions.

BackgroundThe underlying mechanism for stroke in patients with tuberculous meningitis (TBM) remains unclear. This study aimed to investigate the predictors of acute ischemic stroke (AIS) in TBM and whether AIS mediates the relationship between inflammation markers and functional disability.MethodsTBM patients admitted to five hospitals between January 2011 and December 2021 were consecutively observed. Generalized linear mixed model and subgroup analyses were performed to investigate predictors of AIS in patients with and without vascular risk factors (VAFs). Mediation analyses were performed to explore the potential causal chain in which AIS may mediate the relationship between neuroimaging markers of inflammation and 90-day functional outcomes.ResultsA total of 1,353 patients with TBM were included. The percentage rate of AIS within 30 days after admission was 20.4 (95% CI, 18.2–22.6). A multivariate analysis suggested that age ≥35 years (OR = 1.49; 95% CI, 1.06–2.09; P = 0.019), hypertension (OR = 3.56; 95% CI, 2.42–5.24; P < 0.001), diabetes (OR = 1.78; 95% CI, 1.11–2.86; P = 0.016), smoking (OR = 2.88; 95% CI, 1.68–4.95; P < 0.001), definite TBM (OR = 0.19; 95% CI, 0.06–0.42; P < 0.001), disease severity (OR = 2.11; 95% CI, 1.50–2.90; P = 0.056), meningeal enhancement (OR = 1.66; 95% CI, 1.19–2.31; P = 0.002), and hydrocephalus (OR = 2.98; 95% CI, 1.98–4.49; P < 0.001) were associated with AIS. Subgroup analyses indicated that disease severity (P for interaction = 0.003), tuberculoma (P for interaction = 0.008), and meningeal enhancement (P for interaction < 0.001) were significantly different in patients with and without VAFs. Mediation analyses revealed that the proportion of the association between neuroimaging markers of inflammation and functional disability mediated by AIS was 16.98% (95% CI, 7.82–35.12) for meningeal enhancement and 3.39% (95% CI, 1.22–6.91) for hydrocephalus.ConclusionNeuroimaging markers of inflammation were predictors of AIS in TBM patients. AIS mediates < 20% of the association between inflammation and the functional outcome at 90 days. More attention should be paid to clinical therapies targeting inflammation and hydrocephalus to directly improve functional outcomes.

Background:The predictors associated with clinical outcomes in patients with tuberculous meningitis (TBM) remain unclear. We aimed to analyse the relationship between systemic inflammation and clinical outcomes, as well as to explore whether systemic inflammation level influences the effectiveness of dexamethasone on treatment. Methods:Between January 2011 and December 2021, TBM patients admitted to five hospitals were observed consecutively. Baseline and post-treatment systemic inflammation levels were calculated using the neutrophil-lymphocyte-ratio (NLR). Generalized linear mixed models were employed to identify predictors of clinical outcomes. Propensity score matching and subgroup analyses were conducted to evaluate the effect of dexamethasone on treatment outcomes across different NLR levels. Results:A total of 1203 TBM patients were included in the study. During the follow-up, 144 (13.6%) participants experienced early neurological deterioration within 7 days after admission, and 345 (28.67%) exhibited poor functional outcome at the 12-month follow-up. Multivariate analysis revealed that post-treatment NLR was significantly associated with early neurological deterioration (OR=1.25; 95% CI, 1.14-1.33; P<0.001), and poor outcome (OR=1.34; 95% CI, 1.26-1.45; P<0.001). After propensity score matching, dexamethasone treatment was not associated with early neurological deterioration (OR=0.83; 95% CI, 0.42-1.66; P=0.610) or poor outcome (OR=1.22; 95% CI, 0.49-2.11; P=0.490) in the highest quartile of post-treatment NLR. The effect of dexamethasone on treatment outcomes did not significantly vary with disease severity stratification. Conclusion:Elevated systemic inflammation is an independent risk factor for neurological outcome in TBM patients. Further studies are required to investigate systemic inflammation in more severely affected population to better predict the outcomes following anti-inflammatory therapies.

ObjectivesMatrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has emerged as a potent tool for detecting drug resistance in tuberculosis (TB); however, concerns about its reliability have been raised. In this study, we assessed the reliability of MassARRAY (Sequenom, Inc.), which is a MALDI-TOF MS-based method, by comparing it to the well-established GeneXpert assay (Cepheid) as a reference method.MethodsA retrospective study was conducted using laboratory data retrieved from Henan Chest Hospital (Zhengzhou, China). To ensure a rigorous evaluation, we adopted a comprehensive assessment approach by integrating multiple outcomes of the Xpert assay across various specimen types.ResultsAmong the 170 enrolled TB cases, MassARRAY demonstrated significantly higher sensitivity (85.88%, 146 of 170) compared to the Xpert assay (76.62%, 118 of 154) in TB diagnosis (p < 0.05). The concordance in detecting rifampicin resistance between MassARRAY and the combined outcomes of the Xpert assay was 90%, while it was 97.37% (37 of 38) among smear-positive cases and 89.06% (57 of 64) among culture-positive cases. When compared to the phenotypic susceptibility outcomes of the 12 included drugs, consistency rates of 81.8 to 93.9% were obtained, with 87.9% for multiple drug resistance (MDR) identification.ConclusionMassARRAY demonstrates high reliability in detecting rifampicin resistance, and these findings may offer a reasonable basis for extrapolation to other drugs included in the test panel.

Objective: This study aims to estimate the overall in vitro activity of bedaquiline (BDQ) against clinical isolates of Mycobacterium abscessus complex (MABS) and M. avium complex (MAC), considering BDQ as a repurposed drug for non-tuberculous mycobacteria (NTM) infections. Methods: We conducted a systematic review of publications in PubMed/ MEDLINE, Web of Science, and Embase up to 15 April 2023. Studies were included if they followed the Clinical and Laboratory Standards Institute (CLSI) criteria for drug susceptibility testing (DST). Using a random effects model, we assessed the overall in vitro BDQ resistance rate in clinical isolates of MABS and MAC. Sources of heterogeneity were analysed using Cochran's Q and the I 2 statistic. All analyses were performed using CMA V3.0. Results: A total of 24 publications (19 reports for MABS and 11 for MAC) were included. Using 1 mu g/mL and 2 mu g/mL as the breakpoint for BDQ resistance, the pooled rates of in vitro BDQ resistance in clinical isolates of MABS were found to be 1.8% (95% confidence interval [CI], 0.7-4.6%) and 1.7% (95% CI, 0.6- 4.4%), respectively. In the case of MAC, the pooled rates were 1.7% (95% CI, 0.4-6.9%) and 1.6% (95% CI, 0.4-6.8%) for 1 mu g/mL and 2 mu g/mL, respectively. Conclusion: This study reports the prevalence of BDQ resistance in clinical isolates of MABS and MAC. The findings suggest that BDQ holds potential as a repurposed drug for treating MABS and MAC infections. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

2023年8月31日，北京青年呼吸学者沙龙2023年第3次活动在北京顺利举行，本次沙龙主题是“分子生物学技术快速诊断非结核分枝杆菌病的是与非”。活动形式是病例分享和讨论。通过这次活动，与会学者对分子生物学技术快速诊断非结核分枝杆菌病的优势和局限性进行了深入讨论，加深了非结核分枝杆菌病快速诊断的认识。呼吸沙龙新颖的组织和活动形式，获得了与会中青年呼吸学者的好评。

Six months of chemotherapy using current agents is standard of care for pulmonary, drug-sensitive tuberculosis (TB), even though some are believed to be cured more rapidly and others require longer therapy. Understanding what factors determine the length of treatment required for durable cure in individual patients would allow individualization of treatment durations, provide better clinical tools to determine the of appropriate duration of new regimens, as well as reduce the cost of large Phase III studies to determine the optimal combinations to use in TB control programs. We conducted a randomized clinical trial in South Africa and China that recruited 704 participants with newly diagnosed, drug-sensitive pulmonary tuberculosis and stratified them based on radiographic disease characteristics as assessed by FDG PET/CT scan readers. Participants with less extensive disease (N=273) were randomly assigned to complete therapy after four months or continue receiving treatment for six months. Amongst participants who received four months of therapy, 17 of 141 (12.1%) experienced unfavorable outcomes compared to only 2 of 132 (1.5%) who completed six months of treatment (treatment success 98.4% in B, 86.7% in C (difference -11.7%, 95% CI, -18.2%, -5.3%)). In the non-randomized arm that included participants with more extensive disease, only 8 of 248 (3.2%) experienced unfavorable outcomes. Total cavity volume and total lesion glycolysis at week 16 were significantly associated with risk of unfavorable outcome in the randomized participants. Based on PET/CT scans at TB recurrence, bacteriological relapses (confirmed by whole genome sequencing) predominantly occurred in the same active cavities originally present at baseline. Automated segmentation of the serial PET/CT scans was later performed, and machine-learning was used to classify participants according to their likelihood of relapse, allowing the development of predictive models with good performance based on CT, PET, microbiological and clinical characteristics. These results open the possibility for more efficient studies of future TB treatment regimens.

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb) infection, is currently the deadliest infectious disease in human that can evolve to severe forms. A comprehensive immune landscape for Mtb infection is critical for achieving TB cure, especially for severe TB patients. We performed single-cell RNA transcriptome and T-cell/B-cell receptor (TCR/BCR) sequencing of 213,358 cells from 27 samples, including 6 healthy donors and 21 active TB patients with varying severity (6 mild, 6 moderate and 9 severe cases). Two published profiles of latent TB infection were integrated for the analysis. We observed an obviously elevated proportion of inflammatory immune cells (e.g., monocytes), as well as a markedly decreased abundance of various lymphocytes (e.g., NK and γδT cells) in severe patients, revealing that lymphopenia might be a prominent feature of severe disease. Further analyses indicated that significant activation of cell apoptosis pathways, including perforin/granzyme-, TNF-, FAS- and XAF1-induced apoptosis, as well as cell migration pathways might confer this reduction. The immune landscape in severe patients was characterized by widespread immune exhaustion in Th1, CD8+T and NK cells as well as high cytotoxic state in CD8+T and NK cells. We also discovered that myeloid cells in severe TB patients may involve in the immune paralysis. Systemic upregulation of S100A12 and TNFSF13B, mainly by monocytes in the peripheral blood, may contribute to the inflammatory cytokine storms in severe patients. Our data offered a rich resource for understanding of TB immunopathogenesis and designing effective therapeutic strategies for TB, especially for severe patients.

Objective: To assess the efficacy of different antibiotics combined on Mycobacterium abscessus subspecies abscessus pulmonary disease（M.abscessus-PD） and analyze the influencing factors of treatment outcomes for 6 months. Methods: Sixty-six patients in Beijing Chest Hospital, Capital Medical University diagnosed with M.abscessus-PD were enro1led prospectively from January 1st, 2016 to October 1st, 2022. Clinical information of the patients were collected, including gender, age, body mass index, clinical manifestations, history of past illness and anti-tuberculosis treatment, imaging examinations, laboratory examinations and medications. The factors influencing treatment outcomes of M.abscessus-PD for 6 months among different therapicregimens was compared. Results: After 6 months of treatment, 32（48.5%） achieved sputum culture conversion and 34（51.5%） didn’t among the 66 patients. The result shows that the 6-month sputum culture conversion rate of azithromycin users（57.4%, 27/47） was higher than clarithromycin users（26.3%, 5/19）, with statistically significant（χ~2=5.250,P=0.022）. In 24 cases（36.4%, 24/66） treated with imipenem, 17（70.8%, 17/24） achieved 6 months sputum culture conversion, which was higher than that of non-imipenem（35.7%, 15/42）, with statistically significant difference（χ~2=7.542, P=0.006）. The efficacy of multidrug therapy regimen showed that macrolide combined with amikacin, imipenem, linezolid and clofazimine achieved 68.4%（13/19） culture conversion rate after 6 months. Multivariate analysis shows that patients treated with macrolide combined with imipenem were more likely to achieve sputum culture conversion within 6 months（OR（95%CI）=0.229（0.077-0.676））. Conclusion: In the initial stage of treatment, at least 4 weeks of injection use（amikacin and imipenem）, and the combination of macrolides with amikacin, clofazimine, and linezolid in the continued treatment, may have good curative effect on M.abscessus-PD.

Objectives: Patients with Mycobacterium avium complex-pulmonary disease (MAC-PD) can exhibit contraindications in applying the recommended treatment regimens by the guidelines. Clofazimine (CFZ) is considered a promising drug for MAC-PD treatment and is frequently included in alternative regimens; however, its efficacy remains unclear. Methods: MAC-PD patients, unsuitable for standard regimens, were enrolled continuously in a prospective study at Beijing Chest Hospital. The treatment response of the CFZ-containing regimen was monitored. Results: Fifty patients were enrolled in the initial treatment, and 25 patients had a history of anti-TB treatment. Nodular bronchiectasis was observed in 34 patients, while 8 patients exhibited fibrocavitary changes. Additionally, eight patients displayed a combination of both patterns. In a multivariate analysis, MAC-PD patients with CFZ MIC < 0.25 mg/L were significantly associated with culture conversion [OR 8.415, 95% CI (1.983-35.705); P = 0.004]. Among patients who had previous TB treatment history, patients with CFZ MIC < 0.25 mg/L had a higher chance of acquiring culture conversion outcomes [(OR 7.737, 95% CI 1.032-57.989); P = 0.046]. In contrast, among patients with no previous TB treatment history, the RIF-containing regimen had a higher chance of acquiring culture conversion outcomes [(OR 11.038, 95%CI 1.008-120.888); P = 0.049]. Conclusion: MAC-PD patients unsuitable for standard regimens could benefit from a CFZ-containing regimen, especially for patients with previous TB treatment history and baseline CFZ MIC values lower than 0.25 mg/L. (c) 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.

Objective: To detect the cell-free DNA of Mycobacterium tuberculosis (Cf-TB) in the cerebrospinal fluid (CSF) of patients with tuberculous meningitis (TBM), and to assess the diagnostic value of this method for TBM. Methods: We prospectively included patients with suspected meningitis from the Department of Tuberculosis, Beijing Chest Hospital, Department of Neurology, Beijing Chaoyang Hospital and Department of Neurology, 263 Hospital of the People's Liberation Army from September 2019 to March 2022. A total of 189 patients were included in this study. Among them, 116 were male and 73 were female, aged from 7 to 85 years, with an average of (38.5±19.1) years. The CSF specimens of the patients were collected for Cf-TB, MTB culture and Xpert MTB/RIF. SPSS 20.0 was used for statistical analysis and the difference was statistically significant with P<0.05. Results: Among the 189 patients, there were 127 patients in the TBM group and 62 patients in the non-TBM group. The sensitivity of Cf-TB was 50.4% (95%CI 41.4%-59.3%), the specificity was 100% (95%CI 92.7%-100.0%), the positive predictive value was 100% (95%CI 92.9%-100.0%), and the negative predictive value was 49.6% (95%CI 40.6%-58.6%). Using clinical diagnosis as the gold standard, the sensitivity of Cf-TB was 50.4% (64/127), which was significantly higher than that of MTB culture (8.7%, 11/127) and Xpert MTB/RIF (15.7%,20/127) (all P<0.001). Using etiology as the gold standard, the sensitivity of Cf-TB was 72.7% (24/33), which was significantly higher than that of MTB culture [33.3%, 11/33, (χ2=10.28, P=0.001)] and was similar to Xpert MTB/RIF (60.6%, 20/33) (χ2=1.091, P=0.296). Conclusion: The sensitivity of the Cf-TB test was significantly higher than that of CSF MTB culture and Xpert MTB/RIF. Cf-TB may provide evidence for earlier diagnosis and treatment of TBM.

由于人口老龄化和免疫抑制人群的增多等原因,在全世界范围内,非结核分枝杆菌(nontubercu-lous mycobacteria,NTM)病发病率逐渐升高[1-4].尽管NTM病的治疗仍存在疗程长、治愈率低等问题,但近年在治疗领域已经有了一些重要进展,及时掌握这些进展对临床医师提高治疗水平有着重要意义.

Objective: To understand the characteristics of nontuberculous mycobacteria（NTM） pulmonary disease, and provide evidence for clinical diagnosis and treatment of NTM pulmonary disease. Methods: The clinical data of 93 patients with NTM pulmonary disease admitted to Beijing Chest Hospital affiliated to Capital Medical University between January 2018 and December 2019 were analyzed retrospectively. Treatment effectivenesses were compared for different treatment. Results: Among 93 patients with NTM pulmonary disease, there were 49 cases infected with Mycobacterium intracellular, 28 cases with Mycobacterium abscesses, 4 cases with Mycobacterium avium, 4 cases with Mycobacterium kansasii, 3 cases with Mycobacterium xenopi, 2 case co-infected with Mycobacterium abscesses and Mycobacterium intracellular, one case with Mycobacterium gordonii, Mycobacterium fortuitum or Mycobacterium stutzeri each. 61 patients（65.59%） had received antituberculosis treatment before the diagnosis of NTM pulmonary disease. 90（96.77%） patients had complications, of which 52（57.78%） patients had bronchiectasis, followed by 12（13.33%） patients with chronic obstructive pulmonary disease（COPD）. 83 cases（89.25%） received anti-NTM treatment, and 47 cases（56.63%） completed the course of treatment among whom the success rate of the treatment of pulmonary disease with Mycobacterium avium complex was 51.85%（14/27） while the treatment success rate of Mycobacterium abscesses pulmonary disease was 76.92%（10/13）. 48 cases（57.83%） had adverse drug reactions of different degrees during the treatment, and 15 cases（18.07%） discontinued the treatment. 16 patients（19.28%） were lost to follow-up. Conclusion: Mycobacterium intracellular lung disease is the most common NTM pulmonary disease. Most patients were complicated with bronchiectasis, COPD and other basic lung diseases. The clinical characteristics of NTM pulmonary disease and pulmonary tuberculosis are similar, which are easily misdiagnosed as pulmonary tuberculosis. The cure rate of NTM pulmonary disease is low, and the rate of treatment interruption and loss to follow-up is high.