[Errors in diagnosing pulmonary tuberculosis in general hospitals and results of treating the disease]

To specify diagnostic approaches to rapidly progressive destructive pulmonary tuberculosis (RPDPT) in general hospitals and effects of the time of the diagnosis on treatment results.

History, diagnostic techniques and treatment of 162 patients with RPDPT (98 cases with cheesy pneumonia, 37 cases with rapidly progressive infiltrative tuberculosis, 27 cases with rapidly progressive disseminated tuberculosis) were studied.

The diagnosis of tuberculosis was verified for 7 days in 56% patients, in 33% of them the diagnosis took more than 14 days. Tuberculosis was hidden under the mask of inflammatory pulmonary diseases in 60% patients, concomitant pathology--in 19%. Masks were also due to severe intoxication, multiorgan insufficiency, complications, tuberculosis of other organs. RPDPT was diagnosed primarily by x-ray examination, bacteriological test for M. tuberculosis was used in 14%. Lethal outcomes in the group of patients diagnosed for 14 days and longer occurred 2.6 times more frequently than in those diagnosed within 7 days.

The analysis of the diagnostic errors resulted in design of the scheme of the diagnosis of RPDPT including cheesy pneumonia intended for use in general practice with account for possible "masks" of the disease. Basic criteria of the diagnosis are stepwise development of the disease and infiltrative-alterative changes on x-ray picture. Phthisiological alertness of general practitioners in relation to RPDPT must direct the physicians to active detection of M. tuberculosis in the sputum and close cooperation with phthisiologist in complicated diagnostic cases.