Incidence of Tuberculosis and Evaluation of Diagnostic Delay in Admitted Patients During Past Four years at National Hospital Organization Nagasaki Medical Center

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  • YAMAMOTO Kazuko
    国立病院機構長崎医療センター呼吸器科 長崎大学医学部・歯学部付属病院 第二内科
  • OSUMI Mitsuhiko
    国立病院機構長崎医療センター呼吸器科
  • KINOSHITA Akitoshi
    国立病院機構長崎医療センター呼吸器科 長崎大学医学部・歯学部付属病院 第二内科
  • MATSUOKA Yohjiro
    国立病院機構長崎医療センター放射線科
  • YANAGIHARA Katsunori
    長崎大学医学部・歯学部付属病院 第二内科 長崎大学医学部・歯学部付属病院 検査部
  • SAKITO Osamu
    長崎大学医学部・歯学部付属病院 第二内科 大村市立病院 呼吸器科
  • INOUE Yuichi
    健康保険諌早総合病院 呼吸器科
  • FUKUSHIMA Kiyoyasu
    長崎大学医学部・歯学部付属病院 第二内科 日本赤十字社長崎原爆諌早病院 呼吸器科
  • YONEKURA Masahiro
    国立病院機構長崎医療センター脳神経外科
  • KOHNO Shigeru
    長崎大学医学部・歯学部付属病院 第二内科

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  • 長崎医療センターにおける過去４年間の入院中に診断された結核患者背景と診断の遅れについての検討
  • ナガサキ イリョウ センター ニ オケル カコ 4ネンカン ノ ニュウインチュウ ニ シンダンサレタ ケッカク カンジャ ハイケイ ト シンダン ノ オクレ ニ ツイテ ノ ケントウ

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We retrospectively evaluated clinical characteristics of 41 admitted patients who were diagnosed as tuberculosis by results from Ziel-Nielsen smear test and/or culture test and or ligase chain reaction (LCR) method, from January 1999 to December 2002 at National Organization Nagasaki Medical Center in Japan. We also analyzed delay of diagnosis (Diagnostic delay: which means duration required for diagnosis after patient's symptom had appeared) especially in cases with pulmonary tuberculosis. Twenty-eight patients were male and 13 patients were female. Twenty-eight out of 37 patients were of elder age-groups (mean age, 68.4 years; range, 30-86 years). Twenty-nine patients diagnosed as pulmonary tuberculosis, 22 of them were male, and remaining 7 of them were female. Fourteen patients had a past history of pulmonary tuberculosis. Details of underlying diseases in patients with pulmonary tuberculosis were, malignant disease in 10 patients, other pulmonary diseases in 7 patients, cardiovascular diseases in 7 patients, diabetes mellitus in 5 patients, and so on. A total of 82.7% patients were classified as non-cavity type on chest X-ray films for pulmonary tuberculosis. Eleven patients (37.9%) required diagnostic delay of more than one month. Smear-negative pulmonary lung tuberculosis with LCR-positive group were diagnosed significantly earlier (p=0.012) compared to LCR-negative and/or LCR-not examined group. The reasons for late diagnosis were differentiated into two types. First, doctors didn't suspect pulmonary tuberculosis; or second, results of microbiological examinations were delayed. To improve these situations, doctors should constructively examine pulmonary tuberculosis when patients are in elder age-groups and/or have a past history of pulmonary tuberculosis, and or have immuno-compromised diseases. Further, using new diagnostic methods such as broth culture technique or IFN-γ assay with high sensitivity may lead to early diagnosis of tuberculosis. Enlightenment of tuberculosis in general hospital is necessary for avoiding secondary nosocomial infection, with infection control doctors and doctors who belong to respirologv as the leaders.

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