Kobashi Y, Kimura M, Nakamura J, Yano T, Adachi M, Tanabe J, Tano Y, Matsushima T
Department of Medicine, Kawasaki Medical School, Okayama, Japan.
Kekkaku. 1990 Sep;65(9):585-90.
Index case is a 17-year-old boy who was admitted to our hospital with pleurisy and a minimal pulmonary lesion, and tubercle bacilli were recovered from pleural fluid. A diagnosis of primary tuberculosis was made based on the onset by pleurisy and the existence of hilar and mediastinal lymph node swelling. On the same day, a 76-year-old man, grandfather of the index case was admitted for precise examination of suspected extensive pneumonia. Tubercle bacilli were also isolated from the pus of infected bulla obtained by puncture. Neither of these two cases, however, seemed to be the source of the familial tuberculous infection because of such sudden onset of the disease as pleurisy and pneumonia. Two months later, a 46-year-old man, father of the index case was examined at our hospital. He was considered to be the source of the familial infection because he was diagnosed as tuberculosis with positive smear and a thick wall cavity (3.2 cm in diameter) on the left apex, and abnormal shadow was detected on his chest X-ray already two years ago. The fourth case was a mother of the index case, and wife of the third case, whose chest radiography revealed an infiltrative shadow on the right apex by a family contacts examination. Though tubercle bacilli were not isolated from her sputum, pulmonary lesions considered to be tuberculosis due to their typical location and nature, a positive PPD skin test, and the response to antituberculous drugs.
索引病例是一名17岁男孩，因胸膜炎和轻微肺部病变入院，胸腔积液中检出结核杆菌。根据胸膜炎发病情况以及肺门和纵隔淋巴结肿大的存在，诊断为原发性肺结核。同一天，索引病例的76岁祖父因疑似广泛肺炎入院进行精确检查。穿刺获取的感染性大疱脓液中也分离出结核杆菌。然而，这两例病例似乎都不是家族性结核感染的源头，因为它们发病突然，如胸膜炎和肺炎。两个月后，索引病例的46岁父亲在我院接受检查。他被认为是家族感染源，因为他被诊断为肺结核，痰涂片阳性，左肺尖有一个厚壁空洞（直径3.2厘米），两年前胸部X线检查就发现了异常阴影。第四例是索引病例的母亲，也是第三例的妻子，其胸部X线检查通过家庭接触者检查发现右肺尖有浸润性阴影。虽然痰液中未分离出结核杆菌，但因其典型的位置和性质、PPD皮肤试验阳性以及对抗结核药物的反应，肺部病变被认为是结核病。
