SPUTUM EXAMINATION IN THE SCREENING AND DIAGNOSIS OF PULMONARY TUBERCULOSIS IN THE ELDERLY
SPUTUM EXAMINATION IN THE SCREENING AND DIAGNOSIS OF PULMONARY TUBERCULOSIS IN THE ELDERLY
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DOI：
10.1093/qjmed/81.3.999
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发表时间：
1991-12-01
影响因子：
--
通讯作者：
MORRIS, CDW
中科院分区：
文献类型：
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作者：
MORRIS, CDW
肺结核在老年人中并不罕见，尤其是在机构中的老年人，而且众所周知很难诊断。 患有非空洞性疾病的个体很少会排出杆菌，通常需要阳性培养才能确诊。 放射线检查是一种较差的筛查方法，并且曼图测试在该人群中的作用存在争议。 因此，研究了痰培养作为咳嗽老年人筛查程序的价值。 在一项为期 26 个月的前瞻性监测研究中，所有老人院的永久居民均因咳嗽 3 周或更长时间而被纳入研究，无论任何已知或推测的原因如何。 对痰标本进行了涂片和培养，并对痰液阳性的患者进行了曼图试验和胸片检查。 205 名受试者进行了 446 份涂片检查，其中 7 份涂片呈抗酸杆菌阳性，433 份培养结果呈阳性，其中 32 份呈结核分枝杆菌阳性。 从这 19 名肺结核患者中被鉴定出来，其中 18 名患者在胸部 X 线检查中发现非空洞性疾病。 这些患者体内的杆菌数量很少，而且排泄方式也很随意。 涂片对于诊断该人群中的非空洞性结核病不够敏感，必须进行痰培养以排除诊断。 需要四次阴性培养才能排除肺结核的存在。
Pulmonary tuberculosis is not uncommon in the elderly, particularly those in institutions, and is notoriously difficult to diagnose. Few bacilli are excreted by individuals with non-cavitating disease and positive cultures are usually required to confirm the diagnosis. Radiography is a poor screening method, and the role of the Mantoux test in this population controversial. The value of sputum culture as a screening procedure in elderly people with a productive cough was therefore investigated. In a prospective surveillance study over 26 months, all permanent residents in homes for the elderly were entered on the basis of a productive cough for 3 weeks or more irrespective of any known or presumed cause. Both smears and cultures were performed on sputum specimens, and Mantoux tests and chest radiographs were performed on those who were sputum positive.The 205 subjects investigated yielded 446 smears, seven of which were positive for acid-fast bacilli, and 433 cultures, 32 of which were positive for M. tuberculosis. From this 19 patients with pulmonary tuberculosis were identified, 18 of whom had non-cavitating disease on chest radiography. The numbers of bacilli in these patients were shown to be low and the excretion pattern haphazard. Smears were not sufficiently sensitive to diagnose non-cavitating tuberculosis in this population, and the sputum must be cultured in order to exclude the diagnosis. Four negative cultures are required in order to exclude the presence of pulmonary tuberculosis.