[Current status and problems of tuberculosis. 10 years of experience in a general medicine department]

One hundred and seventeen cases of tuberculous disease who came to the Authors' observation in 10 years are described. Some cases are illustrated in details just to point out the complexity and the different guises of clinical presentation and to underscore the importance of an high index of suspicion for tuberculosis in patients who are admitted to a ward of internal medicine. In 71 patients with active, progressive tuberculous disease, the diagnosis was confirmed by bacteriological findings in 29 cases and by bioptical and hystological data in 5 cases; in the remaining 37 cases only clinical and radiological criteria were met but the diagnosis was confirmed by the improvement which was observed after antimycobacterial therapy. Many difficulties have been met in the differential diagnosis between pulmonary tuberculosis and bronchogenic carcinoma in those cases with anamnestic and radiological data of previous pulmonary tuberculosis. When the radiological site of lesions was in the posterior segments of the lung, tuberculosis was the most probable diagnosis, while bronchogenic carcinoma is most oftenly localized in the anterior segments; only in 5 cases of the Author's series the above mentioned criterion was not satisfied. In 46 cases with clinical signs of inactive tuberculous disease which had not been adequately treated with chemotherapy, isoniazid was given only to those patients with a high risk of reactivation (silicosis, diabetes, chronic alcholism, gastric resection, prolonged steroid therapy). Two cases of isoniazid hepatitis were observed among patients treated by the Authors.