Clinical Analysis Of 77 Casses Of Adult Atypical Pulmonary Tuberculosis

National epidemiological survey in 2000 estimated that the national active tuberculosis about 500 people,200 million infectious TB patients, TB mortality rate was 122/10 million. In recent years, picked up the TB epidemic, the elderly increased incidence, and complications associated with underlying diseases, and antibiotics, anti-TB drugs widespread irrational use resulted in tuberculosis and other lung diseases having diverse clinical signs and symptoms, and often making difficulties to diagnose. In this paper, I collect the patients suffering atypical tuberculosis between 2009 and 2010 in our hospital, analyzing clinical data and discussing its diagnostic methods and the factors affecting the diagnosis, to improve the diagnosis and differential diagnosis and reduce misdiagnosis and reduce the spread of tuberculosis.Objective:To investigate the diagnosis of atypical tuberculosis and the factors affecting diagnosis.Methods:We collected 77 cases of atypical tuberculosis from January 2009 to December 2010 in the First Hospital of Jilin University, its clinical manifestations, treatment before admission, underlying diseases and complications, laboratory tests, imaging, diagnosis, were respectively analyzed.Results:In the 77 patients,19 patients (24.7%) have no clinical symptoms; having a pre-hospital course 1 day to 2 years, the average is 130.2 days; 35 patients (45.6%) received pre-hospital treatment; 26 (33.8%)patients associated with underlying diseases and complications, underlying diseases as diabetes, of which 14 patients (18.2%),12 cases of pneumonia (15.6%); chest imaging showed 27 cases (35.1%) patients showed consolidation,46 patients (59.8%) patients showed a solitary nodule or mass shadow; 21 cases (27.3%) in the right upper lobe, and 19 cases (24.7%) in left upper lobe; 1 patients underwent 18F-FDG PET-CT examination, suggesting that FDG uptake increased. Methods in the diagnosis,4 patients (5.2%) were sputum smear positive for acid-fast stain and confirmed; 6 cases (7.8%) were positive for acid-fast bacilli smear fluid and clear diagnosis,15 patients (19.5%) patients via bronchial lung biopsy (TBLB) to obtain a clear diagnosis of pulmonary tuberculosis living tissue; 7 patients (9.1%) patients with lung CT or ultrasound-guided puncture to obtain histopathology, diagnosed as tuberculosis; 2 cases (2.6%) underwent thoracoscopy and clear lung biopsy diagnosis,43 patients (55.8%) patients by surgical removal of lesions, to obtain the pathological diagnosis.Conclusions:1. The patients suffering atypical pulmonary tuberculosis are with atypical clinical manifestations and not typical imaging characteristics, so the diagnosis is difficult.2. If the imaging showed consolidation, but no significantly improved with antibiotic treatment, or the imaging shows a solitary nodule or mass shadow, but the patients with no obvious clinical syndrome, especially the ones with factors such as diabetes, long application of glucocorticoid etc, we need to alert the existence of tuberculosis.3. Fiberoptic bronchoscopy and CT guided percutaneous lung biopsy in the diagnosis of atypical pulmonary tuberculosis have high positive diagnostic rate, which is also safe, minimally invasive, so these methods can be widely used in clinical practice.