Prout S, Benatar S R
S Afr Med J. 1980 Nov 22;58(21):835-42.
Sixty-two cases of disseminated tuberculosis seen over a 6-year period in a large teaching hospital are reviewed. The commonest symptoms were cough, loss of weight and appetite, fever and general malaise. Headache, when present, was highly specific for meningeal involvement. Pyrexia, hepatomegaly, evidence of weight loss and adventitious chest sounds were the commonest physical signs. Hyponatraemia, hypo-albuminaemia and abnormal liver function were common. Severe haematological abnormalities were not present in any of the patients. The best diagnostic sources were sputum, bronchial brushings and biopsies of liver and bone marrow. Forty patients (64%) died, 31 deaths being directly attributable to disseminated tuberculosis. Twenty-five patients had associated diseases. More female patients and Black patients died than did males, Whites or Coloureds (mixed race). The duration of symptoms prior to admission was, in general, long in comparison with the interval between admission and death. We should like to re-emphasize the need to consider disseminated tuberculosis early in the differential diagnosis of a wasting pyrexial illness with chest symptoms and signs, even in the absence of a miliary or miliary-like chest radiograph.
回顾了一家大型教学医院在6年期间收治的62例播散性肺结核病例。最常见的症状是咳嗽、体重减轻、食欲减退、发热和全身不适。头痛（若出现）对脑膜受累具有高度特异性。发热、肝肿大、体重减轻迹象和肺部啰音是最常见的体征。低钠血症、低白蛋白血症和肝功能异常很常见。所有患者均未出现严重血液学异常。最佳诊断来源是痰液、支气管刷检以及肝脏和骨髓活检。40例患者（64%）死亡，31例死亡直接归因于播散性肺结核。25例患者伴有其他疾病。女性患者和黑人患者的死亡人数多于男性、白人或有色人种（混血）。一般而言，入院前症状持续时间相较于入院至死亡的间隔时间较长。我们想再次强调，即使没有粟粒样或类似粟粒样的胸部X线片，在鉴别诊断伴有胸部症状和体征的消耗性发热性疾病时，也应尽早考虑播散性肺结核。
