Matsumura T, Watanabe K
Maizuru Municipal Hospital, Kyoto, Japan.
Kekkaku. 1999 Feb;74(2):129-31.
94 patients with tuberculosis were identified in a 236-bed community general hospital without a dedicated tuberculosis ward from June 1986 to February 1998. 69 patients had bacteriological proof of tuberculosis, and the remaining 25 had clinical evidence thereof. The mean age of all patients was 63.0 years (range: 23-89 years), and the male to female ratio was 2:1. 70 of these cases were admitted. During this same period of time, the total number of inpatients admitted to the internal medicine ward reached around 11,000. Excluding 6 cases who were referred to other hospitals with a tuberculosis ward, the mean duration of hospital stay of the remaining 64 cases was 51.6 days. Among all 94 cases, 62 had pulmonary tuberculosis and the other 32 had extrapulmonary manifestations. The latter group was comprised of 11 with miliary dissemination, 8 pleuritis, 4 osteomyelitis, 2 peritonitis, 2 urinary tract disease, 1 pericarditis, 1 intestinal disease, 1 meningitis, 1 intracranial tuberculoma and 1 genital disease. 3 cases of miliary tuberculosis with dissemination died with antemortem diagnoses of fever of unknown origin, pneumonia, and lung cancer with brain metastasis. These 3 cases illustrate the importance of heightened suspicion of tuberculosis among our patient population. Referral of patients with positive sputum smears to hospitals with a tuberculosis ward has occasionally been difficult because of inaccessibility. Critical comorbid diseases such as chronic renal failure requiring hemodialysis and malignancies are additional limiting factors to transfer to such facilities. Therefore, because of the prevalence and extent of this disease, its myriad clinical presentations, challenges associated with establishing an early diagnosis, and need to prevent spread to family, other patients, and staff, dedicated beds for care of tuberculosis in general hospitals are mandatory.
1986年6月至1998年2月期间，在一家拥有236张床位但没有专门结核病病房的社区综合医院里，共确诊了94例结核病患者。其中69例有结核病的细菌学证据，其余25例有临床证据。所有患者的平均年龄为63.0岁（范围：23 - 89岁），男女比例为2:1。这些病例中有70例被收治入院。在同一时期，内科病房收治的住院患者总数约为11000人。排除6例转诊至设有结核病病房的其他医院的患者后，其余64例患者的平均住院时间为51.6天。在这94例病例中，62例患有肺结核，另外32例有肺外表现。后一组包括11例血行播散型、8例胸膜炎、4例骨髓炎、2例腹膜炎、2例泌尿系统疾病、1例心包炎、1例肠道疾病、1例脑膜炎、1例颅内结核瘤和1例生殖器疾病。3例血行播散型粟粒性肺结核患者在生前被诊断为不明原因发热、肺炎和肺癌伴脑转移后死亡。这3例病例说明了在我们的患者群体中提高对结核病怀疑的重要性。由于交通不便，将痰涂片阳性的患者转诊至设有结核病病房的医院有时会很困难。诸如需要血液透析的慢性肾衰竭和恶性肿瘤等严重合并症是转至此类机构的额外限制因素。因此，鉴于这种疾病的流行程度、临床表现的多样性、早期诊断面临的挑战以及防止传播给家人、其他患者和工作人员的必要性，综合医院必须设有专门的结核病护理床位。
