DELAYED DIAGNOSIS OF TUBERCULOSIS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION
DELAYED DIAGNOSIS OF TUBERCULOSIS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION
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DOI：
10.1016/0002-9343(90)90375-n
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发表时间：
1990-10-01
影响因子：
5.9
通讯作者：
BARNES, PF
中科院分区：
文献类型：
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作者：
KRAMER, F;MODILEVSKY, T;BARNES, PF
目的：确定伴随人类免疫缺陷病毒(HIV)感染的患者结核病诊断延迟的频率，并找出延迟诊断的原因。患者和方法：我们回顾了连续52名HIV感染患者的医疗记录，这些患者在一家拥有1900张床位的综合医院就诊，该医院服务于洛杉矶(美国加利福尼亚州)的主要贫困人口，那里艾滋病毒感染和结核病的发病率很高。晚期治疗(LT)组25例，死亡前未治疗(n=6)或发病后22天以上治疗(n=19)。早期治疗(ET)组包括27名患者，他们在发病后不到16天开始抗结核治疗。结果：LT组和ET组的症状、体征、实验室检查、胸片提示结核的异常(肺门结节、胸腔积液、粟粒样改变、空洞、以上叶为主的浸润性病变)以及伴发的非结核疾病的发生率在LT组和ET组相似。在25名LT组患者中，有21名(84%)的结核病延迟诊断是由于管理上的错误。最常见的错误是未能获得至少三份抗酸涂片和分枝杆菌培养的痰样本，这些患者的临床和胸部X光检查结果与结核病相符(15例)。41例肺结核患者痰涂片抗酸染色阳性25例(61%)。19例患者中8例粪便抗酸涂片阳性(42%)。血培养48例中18例(38%)检出结核分枝杆菌。结论：本中心HIV感染者延迟治疗结核病是常见的，不是由于结核病的不典型表现所致。在大多数情况下，如果获得足够数量的抗酸涂片和分枝杆菌培养的痰样本，如果对有症状的患者进行经验性抗结核治疗，胸部X光检查结果提示有分枝杆菌病，延误是可以避免的。
Purpose: To determine the frequency with which the diagnosis of tuberculosis is delayed in patients with concomitant human immunodeficiency virus (HIV) infection, and to identify reasons for such delays. Patients and methods: We reviewed medical records of 52 consecutive HIV-infected patients with culture-proven tuberculosis seen at a 1,900-bed general hospital serving a predominantly indigent population in Los Angeles (California, USA) where the prevalences of HIV infection and tuberculosis are high. The late-treatment (LT) group consisted of 25 patients in whom tuberculosis was untreated prior to death (n = 6) or treated more than 22 days after presentation (n = 19). The early-treatment (ET) group comprised 27 patients in whom antituberculous therapy was begun less than 16 days after presentation. Results: Symptoms, physical and laboratory findings, chest roentgenographic abnormalities suggestive of tuberculosis (hilar adenopathy, pleural effusion, miliary pattern, cavitation, predominant upper lobe infiltrate), and frequencies of concomitant nontuberculous disease were similar in LT and ET groups. Delayed diagnosis of tuberculosis was attributable to errors in management in 21 (84%) of 25 LT group patients. The most common error was failure to obtain at least three sputum samples for acid-fast smear and mycobacterial culture in patients with clinical and chest roentgenographic findings compatible with tuberculosis (15 cases). Acid-fast sputum smears were positive in 25 (61%) of 41 cases of pulmonary tuberculosis. Acid-fast smears of stool were positive in eight 42%) of 19 cases. Blood cultures yielded Mycobacterium tuberculosis in 18 (38%) of 48 cases. Conclusions: Delayed therapy of tuberculosis in HIV-infected patients at our medical center was common and was not due to atypical manifestations of tuberculosis. In most cases, delays could have been avoided if adequate numbers of sputum samples for acid-fast smear and mycobacterial culture had been obtained, and if empiric antituberculous therapy had been given to symptomatic patients in whom chest roentgenographic findings were suggestive of mycobacterial disease.