Banda H T, Harries A D, Welby S, Boeree M J, Wirima J J, Subramanyam V R, Maher D, Nunn P A
Department of Medicine, College of Medicine, Chichiri, Blantyre, Malawi.
Trans R Soc Trop Med Hyg. 1998 Mar-Apr;92(2):161-3. doi: 10.1016/s0035-9203(98)90727-1.
The prevalence of pulmonary tuberculosis (PTB) in patients with short duration of cough was determined. Ninety-eight adult out-patients (60 men, 38 women; mean age 32 years) at Queen Elizabeth Central Hospital, Blantyre, Malawi, who had cough for 1-3 weeks which was unresponsive to a course of antibiotics, were successfully screened by microscopy and culture of 2 or 3 sputum specimens and chest radiography; 34 (35%) had PTB. Ten patients were sputum smear-positive and 24 were smear-negative and culture-positive. There was no difference in age, gender or clinical features of general illness, respiratory disease and HIV-related disease between patients with PTB and those with no evidence of PTB. Nine patients (26%) with microbiologically confirmed tuberculosis (TB) had chest radiograph abnormalities consistent with TB, compared with 5 (8%) of patients with no microbiological evidence of TB. Certain classes of patients with a short history of cough would benefit from PTB screening strategies with the emphasis on sputum examination rather than chest radiography, which is unreliable in such patients. The classes include (i) patients with other features of TB whose cough has not improved with antibiotic therapy, (ii) seriously ill patients, and (iii) patients in high risk institutions such as prisons and refugee camps.
我们确定了咳嗽时间较短的患者中肺结核（PTB）的患病率。在马拉维布兰太尔伊丽莎白女王中央医院，对98名成年门诊患者（60名男性，38名女性；平均年龄32岁）进行了研究，这些患者咳嗽1 - 3周，对抗生素疗程无反应，通过对2或3份痰标本进行显微镜检查和培养以及胸部X光检查成功进行了筛查；其中34人（35%）患有PTB。10名患者痰涂片阳性，24名患者涂片阴性但培养阳性。患有PTB的患者与无PTB证据的患者在年龄、性别或一般疾病、呼吸系统疾病和HIV相关疾病的临床特征方面没有差异。9名（26%）微生物学确诊为结核病（TB）的患者胸部X光片异常与TB相符，而无微生物学TB证据的患者中这一比例为5名（8%）。某些咳嗽病史较短的患者类别将从强调痰检查而非胸部X光检查的PTB筛查策略中受益，因为胸部X光检查在此类患者中不可靠。这些类别包括：（i）有其他TB特征且咳嗽经抗生素治疗未改善的患者，（ii）重症患者，以及（iii）监狱和难民营等高风险机构中的患者。
