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- 住吉 昭信
- 宮崎医科大学病理学教室第一講座
書誌事項
- タイトル別名
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- The present status of tuberculosis in the compromised hosts - Analysis of disseminated tuberculosis.
- ANALYSIS OF DISSEMINATED TUBERCULOSIS
この論文をさがす
抄録
The compromised host is generally defined as a patient who has a primary underlying disease or is receiving therapy that impairs resistance to infection. It is considered that anergy (loss of delayed hypersensitivity to tuberculoprotein) in the compromised hosts is associated with severe, uncontrolled tuberculous infection due to loss of resistance which may seed mycobacteria into bloodstream, resulting in generalized dissemination and/or tuberculous meningitis.<BR>The changing pattern and present status of disseminated and/or miliary tuberculosis were examined in autopsy cases in relation to the role of the compromised states in causing disseminated tuberculosis. Three hundred and forty seven cases of disseminated tuberculosis were compiled by reviewing the Annual of Pathological Autopsy Cases in Japan (APACJ), 1982-1983. All the organs preserved in fixative were grossly reexamined in detail and microscopic slides were made again in 43 cases autopsied in Kyushu. In addition to these slides, the original microscopic slides obtained at autopsy and urotocol were reviewed together.<BR>The overall incidence of disseminated tuberculosis recorded in APACJ was 0.44% (347/78, 341). Patients of 50 years of age and over occupied 85 % of study subjects. The incidence of disseminated tuberculosis was 0.17% (84/48, 740) in cases with malignant neoplasms, 1.43% (10/699) in cases with collagen diseases, and 1.06% (12/1, 138) in cases with diabetes mellitus. The prevalence of dissemination did not always correlate with any malignancy in this study but with corticosteroid therapy, especially in cases with collagen diseases.<BR>Only 11% of cases with disseminated tuberculosis and/or tuberculous meningitis were correctly diagnosed before autopsy.<BR>Examination of the lung and draining hilar and paratracheal lymph nodes showed old hyalinized granulomas with central or peripheral necrosis containing many mycobacteria. These lesions were considered to represent a nidus of chronic persistent tuberculosis and to be the source of the late dissemination in 84% of Kyushu cases. Histopathologically, corticosteroid therapy seemed to produce more severe, and often non-reactive disease.<BR>Reactivation of tuberculosis may occur at any time presumably whenever defenses are lowered in the course of various underlying diseases in the older age groups, many of which are associated with immunosupressive therapy. Therefore, all physicians should have a basic understanding on the present status of tuberculosis, and should keep in mind possible incidence of tuberculosis, especially if the patient develops unexplained pyrexia. Accuracy in diagnosis could be greatly improved by maintaining awareness of physicians on tuberculosis and broadening the scope of differential diagnosis to include tuberculosis among patients at high risk, especially in the older age groups.
収録刊行物
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- 結核
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結核 62 (2), 41-50, 1987
一般社団法人 日本結核病学会
