[Frequency and morphology of tuberculosis in autopsies: increase of active forms]

Tuberculosis is still a relevant infectious disease, which is clinically often not diagnosed during a patient's lifetime. We investigated the frequency of tuberculosis in autopsies.

3947 autopsy reports from the Institute of Pathology at the Ruhr University Bochum,were analysed for the period from 1990 to 2004. Tuberculosis was mentioned in 148 reports.

55 (1.39%) cases showed relevant tuberculosis. In 39 (70.9%) cases further other relevant diseases were diagnosed. Lung involvement was grossly present in 52 (94.6%) cases. Of the active forms, 16 (29.1%) showed acinar nodal foci, 15 (27.3%) so-called early cavities and 10 (18.2%) caseous pneumonia. Miliary tuberculosis was found in 8 (14.5%) cases, tubercular meningoencephalitis in 7 (12.7%), and tuberculosis of the spine in 4 (7.3%). The inactive forms showed scarring or pleural adhesions (n = 30, 54.5%), late cavities and mycetomas (n = 9, 16.3%). Active forms of tuberculosis were more frequent in the age groups from 30 to 59 and 80 to 99 years. In the last period of the study an increase in active forms (22:2 = 91.7% vs. 18:13 = 58.1%, p = 0.0065) was noted, while 10 of 22 (45.5%) cases were not detected clinically. In 13 (0.33%) cases tuberculosis had been diagnosed as requiring treatment but no tuberculosis was found at autopsy.

Early diagnosis of tuberculosis is very important for patients and for inhibiting a possible spread of bacteria, especially considering the increase in frequency of active forms of tuberculosis. Autopsies are still indispensable for providing quality control and disease statistics.