Yamamoto Akito, Tsuchiya Kayoko, Kusajima Kenji, Shimoide Hisao, Nunomura Maki, Hebisawa Akira
Mishima Kyoritsu Hospital, Mishima-shi, Shizuoka, Japan.
Kekkaku. 2009 Feb;84(2):71-8.
To clarify clinico-pathological features of tuberculosis found at autopsy.
This study investigates 18 (3.7%) of active pulmonary tuberculosis out of 489 autopsy in Tachikawa Sougo Hospital during the period from 1992 to 2005.
There were 11 men and 7 women, with a median age of 69.5 years. Tubercle bacilli were proved from sputum in 6, which consisted of 3 with positivity on sputum smear microscopy and culture, and 3 with positivity only on sputum culture. Two were examined, but not diagnosed before death. Three didn't show any positive result despite of repeated sputum tests. The features of the chest radiological findings were: (1) Shadows that present prior tuberculosis (ex: nodules, fibrotic lesion) were found in 9 and ground-glass-opacity in 5. (2) In 6, radiological findings consistent with tuberculosis were not pointed out because shadows such as fibrosis, pleural effusion, or cancer were mixed in the same lung. (3) In 11, main radiological findings were found in atypical segments, when there were some underlying conditions such as the use of corticosteroidal therapy or diabetes mellitus. Four were diagnosed correctly, and treated with anti-tuberculosis drugs. Other 14 were not diagnosed before death and diagnosed wrongly as pneumonia, cancer, or other diseases. Encapsulated caseous nodules were seen in 7, and autopsy confirmed that 12 including these 7 were caused by endogenous reactivation. Miliary tuberculosis was found in 5, caseous pneumonia/bronchitis in 6. One had tuberculous empyema. As to underlying diseases, 8 had malignant disease, 6 had diabetes mellitus and 6 were treated with corticosteroids.
This study suggests that sputum culture or radiological findings are not sufficient enough to diagnose tuberculosis, especially in compromised host. We emphasize the vital role of treatment for latent tuberculosis for cases with high risk of endogenous reactivation, and it's necessary to make the guideline for the treatment of such latent tuberculosis.
阐明尸检时发现的结核病的临床病理特征。
本研究调查了1992年至2005年期间立川综合医院489例尸检中的18例（3.7%）活动性肺结核病例。
男性11例，女性7例，中位年龄69.5岁。6例痰中检出结核杆菌，其中3例痰涂片显微镜检查和培养均阳性，3例仅痰培养阳性。2例进行了检查，但生前未确诊。3例尽管多次痰检均未显示任何阳性结果。胸部影像学表现为：（1）9例发现既往结核病灶（如结节、纤维化病变）阴影，5例发现磨玻璃影。（2）6例因肺部存在纤维化、胸腔积液或癌症等阴影混合，未指出符合结核病的影像学表现。（3）11例在存在皮质类固醇治疗或糖尿病等基础疾病时，主要影像学表现位于非典型节段。4例得到正确诊断并接受抗结核药物治疗。其他14例生前未确诊，被误诊为肺炎、癌症或其他疾病。7例可见包膜干酪样结节，尸检证实包括这7例在内的12例由内源性再激活引起。5例发现粟粒性结核，6例发现干酪性肺炎/支气管炎。1例有结核性脓胸。关于基础疾病，8例患有恶性疾病，6例患有糖尿病，6例接受皮质类固醇治疗。
本研究表明，痰培养或影像学表现不足以诊断结核病，尤其是在免疫功能低下的宿主中。我们强调对于有内源性再激活高风险的病例，潜伏性结核治疗的重要作用，并且有必要制定此类潜伏性结核的治疗指南。
