Studies on the changes in clinical features of tuberculosis

Abstract

The epidemiological and clinical features of tuberculosis have largely changed in recent years owing to rapid improvement of social environments and therapeutics. For the determination of these changes, especially clinical ones, the author made comparative studies on all patients hospitalized in National Sanatorium Higashi Saitama Hospital during the periods from 1964 to 1966 and from 1985 to 1988. The 1964-66 group included 400 patients and the 1985-88 group included 508, making a total of 908. The results are as follows: 1. Primary treatment cases with positive bacteriology, atypical mycobacteriosis cases and those with complications increased in number, while re-treatment cases decreased. 2. Comparison was made for bacteriologically positive primary treatment cases between the two groups, namely 112 patients of 1964-66 group and 213 patients of 1985-88 group. The results were: (1) 1985-88 group included larger number of more aged patients and patients with complications. (2) The two groups showed no marked differences in radiological findings such as the size of affected areas or cavities and the rate of cavitation. The patients with radiologically fibrocaseous findings increased in number. (3) The incidence of lower lung field tuberculosis was almost doubled in the 1985-88 group, and this type of tuberculosis was more frequently observed among patients below 29 and over 70 years of age and among those complicated with diabetes mellitus. In chest CT, eight out of 10 patients with lower lung field tuberculosis showed some changes in their mediastinum and/or hilar lymph nodes. This may suggest that the primary mediastinum and/or hilar lymph nodes tuberculosis had perforated into the trachea or bronchi. (4) Although the two groups did not show difference in mortality, deaths due to complications were observed more in the 1985-88 group. However, 4 patients in this group died of tuberculosis itself, all within about 40 days after hospitalization.