Crump John A, Reller L Barth
Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina 27710, USA.
Clin Infect Dis. 2003 Oct 15;37(8):1037-43. doi: 10.1086/378273. Epub 2003 Sep 24.
We describe the clinical presentation, predisposing conditions, diagnostic approach, and outcome for 52 patients with disseminated tuberculosis who presented at Duke University Medical Center (Durham, NC) from 1980 through 1999. The mean age of the patients was 52 years (range, 2-93 years). Fever and weight loss were common at presentation, and delays in the initiation of therapy often occurred. Predisposing conditions included human immunodeficiency virus infection (46% of patients), immunosuppressive therapy (21%), alcoholism (12%), diabetes mellitus (12%), and hematologic disorders (8%); 17% of patients had no disorder of immunity detected. Examination of biopsy specimens from sites of localized disease, especially lymph nodes, had a high diagnostic yield. In this study, mycobacterial blood culture appeared to be as sensitive as bone marrow culture in diagnosing disseminated tuberculosis (sensitivity, 58% vs. 54%). To diagnose disseminated tuberculosis, a search for sites of localized disease should be undertaken, and samples from these sites should be obtained. Mycobacterial blood culture can play an increasing role in the diagnosis of disseminated tuberculosis when localized disease is not found.
我们描述了1980年至1999年在杜克大学医学中心（北卡罗来纳州达勒姆）就诊的52例播散性结核病患者的临床表现、易感因素、诊断方法及转归。患者的平均年龄为52岁（范围2至93岁）。发热和体重减轻在就诊时较为常见，且治疗开始往往延迟。易感因素包括人类免疫缺陷病毒感染（46%的患者）、免疫抑制治疗（21%）、酗酒（12%）、糖尿病（12%）和血液系统疾病（8%）；17%的患者未检测到免疫紊乱。对局限性疾病部位（尤其是淋巴结）的活检标本进行检查，诊断阳性率较高。在本研究中，分枝杆菌血培养在诊断播散性结核病方面似乎与骨髓培养一样敏感（敏感性分别为58%和54%）。为诊断播散性结核病，应寻找局限性疾病部位并获取这些部位的样本。当未发现局限性疾病时，分枝杆菌血培养在播散性结核病的诊断中可发挥越来越大的作用。
