Siakia U N, Vishwajeet V, Kumar R, Suri V, Joshi K, Radotra B
Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India.
Int J Tuberc Lung Dis. 2021 Apr 1;25(4):271-276. doi: 10.5588/ijtld.20.0802.
One of the most severe forms of TB, disseminated TB (dTB) is associated with significant mortality. A retrospective study was undertaken to assess the proportion of dTB among inpatient deaths and to describe the pathological spectrum of lesions. Associated comorbidities and missed dTB cases ante-mortem were also sought. Data on autopsy-confirmed cases of dTB from over three decades (1988-2016) obtained from the departmental archives of the Post Graduate Institute of Medical Education and Research, Chandigarh, India, were reviewed for clinical details, as well as gross and histopathological findings. The proportion of autopsy-confirmed dTB were reported. During this period, a total of 243 autopsy-confirmed cases were retrieved. The organs most commonly involved in these cases were the lungs (90.1%), followed by the liver (72%), spleen (44%), kidneys (37%), bone marrow (17%), adrenals (12.2%), intestine (11.4%), pancreas (8.5%) and reproductive organs (6.9%). The brain was involved in 73.3% cases. In one third of cases, the diagnosis of TB was not suspected ante-mortem. Comorbid conditions were noted in 36.2% cases. A significant burden of dTB was noted among hospital inpatient deaths. Due to multi-organ involvement, dTB has atypical symptoms and may remain undiagnosed ante-mortem. Increased awareness and robust screening of TB cases are mandatory, particularly in patients with underlying comorbidities.
播散性结核病（dTB）是最严重的结核病形式之一，与显著的死亡率相关。一项回顾性研究旨在评估住院患者死亡中dTB的比例，并描述病变的病理谱。还探寻了相关的合并症以及生前漏诊的dTB病例。对从印度昌迪加尔医学教育与研究研究生院的科室档案中获取的三十多年（1988 - 2016年）尸检确诊的dTB病例数据进行了回顾，以获取临床细节以及大体和组织病理学发现。报告了尸检确诊的dTB比例。在此期间，共检索到243例尸检确诊病例。这些病例中最常受累的器官是肺（90.1%），其次是肝脏（72%）、脾脏（44%）、肾脏（37%）、骨髓（17%）、肾上腺（12.2%）、肠道（11.4%）、胰腺（8.5%）和生殖器官（6.9%）。73.3%的病例脑部受累。三分之一的病例生前未怀疑结核病诊断。36.2%的病例有合并症记录。在医院住院患者死亡中发现了相当数量的dTB病例。由于多器官受累，dTB有非典型症状，可能生前未被诊断。提高对结核病的认识并加强对结核病病例的筛查是必不可少的，特别是对有潜在合并症的患者。
