[Clinical investigation of severe pulmonary tuberculosis and miliary tuberculosis]

Although the incidence of pulmonary tuberculosis had been rapidly decreased in Japan, it is pointed out that the rate of decrease in annual incidence became smaller in recent years. This slowing down of the rate of decrease is considered to be resulted from an increase in number of individuals who are more susceptible to tuberculous infection; such as the elderly, young people who are not exposed to TB bacilli previously and therefore not immunized, patients with malignant disease or with organ transplantation and HIV-infected persons. Pulmonary tuberculosis still remained as a pulmonary infectious disease of highly ranked importance. Especially, miliary tuberculosis is life-threatening and occasionally fatal unless early intensive antituberculosis chemotherapy was started on the basis of a rapid and definite diagnosis. We made a retrospective survey to clarify the characteristic clinical features of miliary tuberculosis. For this purpose, we compared the characteristics and clinical features of 10 patients with miliary tuberculosis and those of 18 patients with severe pulmonary tuberculosis, not due to hematogenous dissemination. The mean ages of miliary tuberculosis group and that of severe pulmonary tuberculosis group were 62.6 and 63.8 years old, respectively, with no significant difference. Nine out of ten patients with miliary tuberculosis had fever as one of initial symptoms, whereas, all the patients with severe pulmonary tuberculosis had cough and sputa but they seldom developed fever (high fever) at the initial stage of their diseases. Duration from onset of symptom to the admission was 1.2 months on average in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)