Minakuchi M, Mochizuki Y, Nakahara Y, Kawanami R, Kawamura T, Tsuyuguchi K, Kimoto T
Department of Internal Medicine, National Himeji Hospital, Hyougo, Japan.
Kekkaku. 1996 Jan;71(1):1-5.
We analyzed retrospectively the clinical data of 12 patients diagnosed as pulmonary tuberculosis after admission to the National Himeji Hospital during the past 5 years. Ten out of 12 patients were male and were of elder age-groups (mean age: 65.5 years, range: 32-76 years). Seven patients at first visited the department of respiratory medicine, and the remaining three patients were admitted without consulting the department of respiratory medicine before admission. Only patient had a history of pulmonary tuberculosis. Two patients were suspected of pulmonary tuberculosis on admission. Tubercle bacilli were positive sputum smear in 6 patients, sputum culture in 1, smear of bronchial washing in 4, and smear of BALF in 1. It took 12.7 days on the average from the admission to make a final diagnosis as pulmonary tuberculosis patients into a general hospital lacking TB ward were as follows: (1) As pulmonary TB was not suspected, Chest X-ray and sputum examination were not performed. (2) The admission was done due to another disease and respiratory symptoms were scarce. (3) Tuberculosis lesions on chest X-ray were harbored by pleural effusions and diffuse shadows. (4) Though pulmonary tuberculosis was suspected, a patient was admitted because of general prostration as sputum smear was negative. After admission, however, repeated sputum culture revealed positive results. (5) Pulmonary tuberculosis developed after the admission.
我们回顾性分析了过去5年中入住姬路市立医院后被诊断为肺结核的12例患者的临床资料。12例患者中有10例为男性，且年龄较大（平均年龄：65.5岁，范围：32 - 76岁）。7例患者最初就诊于呼吸内科，其余3例患者在入院前未咨询呼吸内科就被收治。仅1例患者有肺结核病史。2例患者入院时被怀疑患有肺结核。6例患者痰涂片结核杆菌阳性，1例痰培养阳性，4例支气管灌洗涂片阳性，1例支气管肺泡灌洗（BALF）涂片阳性。对于一所没有结核病病房的综合医院，从入院到最终诊断为肺结核患者平均需要12.天，原因如下：（1）由于未怀疑肺结核，未进行胸部X光和痰液检查。（2）因其他疾病入院，呼吸道症状较少。（3）胸部X光上的结核病变被胸腔积液和弥漫性阴影掩盖。（4）虽然怀疑患有肺结核，但因痰涂片阴性，患者因全身虚弱而入院。然而，入院后反复痰培养显示阳性结果。（5）入院后发生肺结核。
