Dwyer D E, MacLeod C, Collignon P J, Sorrell T C
Registrar, Department of Medicine, Westmead Hosptial, NSW.
Aust N Z J Med. 1987 Oct;17(5):507-11. doi: 10.1111/j.1445-5994.1987.tb00110.x.
Extrapulmonary tuberculosis (TB) remains a major health problem in Australia, with 24.3% of all new tuberculosis notifications in 1984 of extrapulmonary origin. We have reviewed our recent experience to assess the epidemiology and clinical features that may allow the earlier recognition and treatment of patients at risk for this disease. From 1980-1985, 51 cases of extrapulmonary TB were identified at Westmead Hospital. Thirty-eight patients were born outside Australia, mainly in South-East Asia and Europe. The commonest sites of disease were the lymph nodes, genitourinary tract, pleura and bone. Tuberculous lymphadenitis occurred predominantly in South-East Asians, whilst genitourinary tract disease was confined to Caucasians. A history of previous exposure to tuberculosis was obtained in 45% of patients. Fever, sweats and weight loss were noted in less than half of the cases. Changes consistent with old pulmonary disease were found on routine chest X-ray in 34% of cases. Laboratory confirmation of TB was made in 88% of cases, with typical histopathology in 90% and isolation of Mycobacterium tuberculosis in 69% of specimens submitted for analysis. Drug resistance was confined to isolates from South-East Asian patients.
肺外结核病在澳大利亚仍然是一个主要的健康问题，1984年所有新报告的结核病病例中有24.3%为肺外起源。我们回顾了近期经验，以评估可能有助于早期识别和治疗该病高危患者的流行病学和临床特征。1980年至1985年期间，韦斯特米德医院共确诊51例肺外结核病病例。38名患者出生在澳大利亚境外，主要来自东南亚和欧洲。最常见的发病部位是淋巴结、泌尿生殖道、胸膜和骨骼。结核性淋巴结炎主要发生在东南亚人身上，而泌尿生殖道疾病则仅限于白种人。45%的患者有既往结核接触史。不到一半的病例出现发热、盗汗和体重减轻。34%的病例在常规胸部X光检查中发现与陈旧性肺部疾病相符的变化。88%的病例通过实验室确诊为结核病，90%的病例有典型的组织病理学表现，69%送检分析的标本中分离出结核分枝杆菌。耐药性仅见于东南亚患者的分离株。
