Department of Pulmonary Medicine and Clinical Immunology, Dokkyo University School of Medicine, Mibu-machi, Shimotsuga-gun, Tochigi 321-0293, Japan.
J Infect Chemother. 2011 Oct;17(5):652-7. doi: 10.1007/s10156-011-0239-9. Epub 2011 Apr 9.
To identify problems in early diagnosis of tuberculosis and to design countermeasures against the disease, we examined the status of active tuberculosis among patients admitted to a university hospital that did not have an isolation ward for tuberculosis. Between 2005 and 2007, we analyzed demographic characteristics, disease type, chest radiologic findings, and the process leading to diagnosis. Active tuberculosis was diagnosed after admission in 55 patients (34 males and 21 females): pulmonary tuberculosis, 26; tuberculous pleuritis, 13; tuberculous meningitis, 6; miliary tuberculosis, 4; tuberculous pericarditis, 3; lymph-node tuberculosis, 2; and tracheal and bronchial tuberculosis, 1. Although radiographic examinations provided abundant information, chest radiography showed normal findings in 7 patients (12.7%). Computed tomographic scanning was useful for detailed evaluation of abnormalities. Twenty patients (36.4%) were given diagnoses at departments other than ours (Department of Pulmonary Medicine). Numbers of days between hospital admission and diagnosis of tuberculosis (50th percentile/80th percentile) were 8.0/37.8 for miliary tuberculosis, 8.0/8.0 for tracheal and bronchial tuberculosis, 7.5/17.8 for tuberculous pleuritis, 7.0/8.8 for tuberculous pericarditis, 6.0/15.6 for pulmonary tuberculosis, 3.5/4.4 for lymph-node tuberculosis, and 1/1 for tuberculous meningitis. Early diagnosis of tuberculosis requires adherence to the following precautions. Tuberculosis should be suspected in any patient with respiratory symptoms. Sputum tests for acid-fast bacteria should be performed at least three times initially. If findings on chest X-ray films are equivocal, high-resolution computed tomography should be performed to confirm details of shadows and to detect minimal pulmonary shadows or cavitary lesions. Physicians from all specialties should be repeatedly informed about the risk of tuberculosis and should include tuberculosis in the differential diagnosis in patients suspected to have pulmonary diseases.
为了发现结核病早期诊断中存在的问题并制定相应的防治对策，我们对一所没有结核病隔离病房的大学医院的住院患者中活动性结核病的发病情况进行了调查。在 2005 年至 2007 年期间，我们对患者的人口统计学特征、疾病类型、胸部影像学表现以及诊断流程进行了分析。在 55 例患者（34 例男性，21 例女性）中确诊为活动性结核病：肺结核 26 例，结核性胸膜炎 13 例，结核性脑膜炎 6 例，粟粒性肺结核 4 例，结核性心包炎 3 例，淋巴结结核 2 例，气管和支气管结核 1 例。尽管影像学检查提供了丰富的信息，但 7 例（12.7%）患者的胸部 X 线片结果正常。计算机断层扫描有助于详细评估异常情况。20 例（36.4%）患者的诊断并非由我们科室做出（呼吸内科）。粟粒性肺结核患者从住院到确诊的天数（中位数/80%分位数）为 8.0/37.8 天，气管和支气管结核患者为 8.0/8.0 天，结核性胸膜炎为 7.5/17.8 天，结核性心包炎为 7.0/8.8 天，肺结核为 6.0/15.6 天，淋巴结结核为 3.5/4.4 天，结核性脑膜炎为 1.0/1.0 天。结核病的早期诊断需要注意以下几点。对于任何有呼吸道症状的患者，都应怀疑患有结核病。最初至少应进行 3 次痰抗酸杆菌检查。如果胸部 X 线片的结果不确定，应进行高分辨率 CT 检查以确认阴影的细节，并发现微小的肺部阴影或空洞性病变。应反复向各科室的医生通报结核病的风险，并在怀疑患有肺部疾病的患者中纳入结核病的鉴别诊断。
