Marciniuk D D, McNab B D, Martin W T, Hoeppner V H
Division of Tuberculosis Control, The Research Center for the Elimination of Tuberculosis, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.
Chest. 1999 Feb;115(2):445-52. doi: 10.1378/chest.115.2.445.
To describe the early symptoms of pulmonary tuberculosis (TB) when the chest radiograph (CXR) is normal.
Centralized, provincial TB control program.
Twenty-five patients with culture-positive pulmonary TB and a normal CXR were identified from a review of 518 consecutive patients with culture-positive pulmonary TB in the province of Saskatchewan from January 1, 1988 to March 31, 1997. Patients with abnormal CXRs at the time of diagnosis were excluded from the analysis.
Twenty-three of the 25 patients (92%) were symptomatic at the time of diagnosis, with cough/sputum (76%) being reported most commonly. Eleven patients were identified because of contact tracing from cases of infectious pulmonary TB, while the other 14 patients were identified because of an investigation of symptoms. Twenty-four patients (96%) exhibited one or more symptoms of cough for > 1 month, fever for > 1 week, or skin-test conversion after contact with infectious TB. The sputum smear of only one patient was positive. Two patients were pregnant at the time of diagnosis, one patient was HIV-positive, and one patient demonstrated isoniazid-resistant organisms on sensitivity testing. Five patients were diagnosed as having primary TB associated with Mantoux skin-test conversion. The incidence of culture-positive pulmonary TB with a normal chest radiograph was < 1% in the period from 1988 to 1989 and steadily increased to 10% in the period from 1996 to 1997.
Culture-positive pulmonary TB with a normal CXR is not uncommon, and the incidence of this presentation is increasing. Patients with this presentation of TB are typically symptomatic and/or are detected by contact tracing to infectious cases of pulmonary TB. The results suggest that patients presenting with a cough for > 1 month, with a fever for > 1 week, or with documented skin-test conversion < 2 years after known exposure to infectious TB should have sputum submitted for a Mycobacterium tuberculosis smear and culture despite a normal CXR.
描述胸部X线片（CXR）正常时肺结核（TB）的早期症状。
省级结核病集中控制项目。
从1988年1月1日至1997年3月31日对萨斯喀彻温省518例痰培养阳性肺结核患者的回顾中，确定了25例痰培养阳性且CXR正常的患者。诊断时CXR异常的患者被排除在分析之外。
25例患者中有23例（92%）在诊断时有症状，最常见的症状是咳嗽/咳痰（76%）。11例患者是通过对传染性肺结核病例的接触者追踪发现的，另外14例患者是通过症状调查发现的。24例患者（96%）出现以下一种或多种症状：咳嗽超过1个月、发热超过1周或接触传染性肺结核后结核菌素皮肤试验阳转。只有1例患者的痰涂片呈阳性。2例患者在诊断时怀孕，1例患者HIV阳性，1例患者在药敏试验中显示对异烟肼耐药。5例患者被诊断为与结核菌素皮肤试验阳转相关的原发性肺结核。1988年至1989年期间，CXR正常的痰培养阳性肺结核的发病率<1%，并在1996年至1997年期间稳步上升至10%。
CXR正常的痰培养阳性肺结核并不少见，且这种表现的发病率正在增加。有这种肺结核表现的患者通常有症状和/或通过对传染性肺结核病例的接触者追踪被发现。结果表明，如果患者咳嗽超过1个月、发热超过1周或在已知接触传染性肺结核后<2年有记录的结核菌素皮肤试验阳转，尽管CXR正常，也应送检痰液进行结核分枝杆菌涂片和培养。
