KNCV Tuberculosis Foundation, The Hague, The Netherlands.
PLoS One. 2011 Apr 4;6(4):e17601. doi: 10.1371/journal.pone.0017601.
The prognosis, specifically the case fatality and duration, of untreated tuberculosis is important as many patients are not correctly diagnosed and therefore receive inadequate or no treatment. Furthermore, duration and case fatality of tuberculosis are key parameters in interpreting epidemiological data.
To estimate the duration and case fatality of untreated pulmonary tuberculosis in HIV negative patients we reviewed studies from the pre-chemotherapy era. Untreated smear-positive tuberculosis among HIV negative individuals has a 10-year case fatality variously reported between 53% and 86%, with a weighted mean of 70%. Ten-year case fatality of culture-positive smear-negative tuberculosis was nowhere reported directly but can be indirectly estimated to be approximately 20%. The duration of tuberculosis from onset to cure or death is approximately 3 years and appears to be similar for smear-positive and smear-negative tuberculosis.
Current models of untreated tuberculosis that assume a total duration of 2 years until self-cure or death underestimate the duration of disease by about one year, but their case fatality estimates of 70% for smear-positive and 20% for culture-positive smear-negative tuberculosis appear to be satisfactory.
未经治疗的肺结核的预后，特别是病死率和持续时间，非常重要，因为许多患者未得到正确诊断，因此未接受充分或未接受治疗。此外，肺结核的持续时间和病死率是解释流行病学数据的关键参数。
为了估计 HIV 阴性患者未经治疗的肺结核的持续时间和病死率，我们回顾了化疗前时代的研究。在 HIV 阴性个体中，未经治疗的涂片阳性肺结核的 10 年病死率有报道在 53%至 86%之间不等，加权平均值为 70%。未直接报告培养阳性涂片阴性肺结核的 10 年病死率，但可间接估计约为 20%。从发病到治愈或死亡的肺结核持续时间约为 3 年，并且似乎与涂片阳性和涂片阴性肺结核相似。
目前假设未经治疗的肺结核总持续时间为 2 年，直至自行治愈或死亡的模型低估了疾病持续时间约 1 年，但它们对涂片阳性和培养阳性涂片阴性肺结核的病死率估计（分别为 70%和 20%）似乎令人满意。
