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題名 | Pancytopenia and Acute Respiratory Failure in Patients with Miliary Tuberculosis:An Analysis of Seven Cases=粟狀結核病併發全血球缺乏和急性呼吸衰竭:七病例分析 |
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作者 | 王甯祺; 張峰義; | 書刊名 | 中華民國感染症醫學會雜誌 |
卷期 | 8:2 1997.12[民86.12] |
頁次 | 頁127-131 |
分類號 | 415.2773 |
關鍵詞 | 粟狀結核病; 全血球缺乏; 急性呼吸衰竭; Miliary tuberculosis; Panyctopenia; Acute respiratory failure; |
語文 | 英文(English) |
中文摘要 | 分析七例罕見粟狀結核病合併全血球缺乏與急性呼吸衰竭病例的臨床表徵、診斷方法及病理發現。全部病人的痰液耐酸性染色均呈陰性。結核菌培養(其中包括痰液三例,腦脊髓液、骨髓、及淋巴腺各一例)結果有五例為陽性。其餘兩例以肺部組織病理切片診。 在三例骨髓病理切片未發現肉芽腫或骨髓細胞缺乏的現象;這些發現與早先的各研究報告不同。病人的死亡率高達71%。由於狀結核病合併急性呼吸衰竭與全血球缺乏的病程惡化快,加上早期病因診斷困難且死亡率高。當簡單檢查方法無確定病因時,必須立即考慮使用侵襲性檢查方法(如肺部組織切片、骨髓切片等),以便能迅速診斷與治療。 |
英文摘要 | Seven cases of miliary tuberculosis presented with pancytopenia and acute respiratory failure were reported. The clinical characteristics, diagnostic methods and pathologic findings were analyzed. Sputum for acid-fast bacilli (AFBs) were negative for all patients. Cultures (sputum, n=3; cerebrospinal fluid, n =2; bone marrow, n =1; lymph node, n=1) showed positive for Mycobacterium tuberculosis in 71% (5/7). The other two patients were diagnosed by histologic results in lung biopsy. Bone marrow biopsy was done in 3 patients, neither granuloma nor hypocellularity was demonstrated. These findings were quite different from previous studies. Mortality rate was up to 71% (5/7). Because of its rapid deterioration and diagnostic difficulties, early recognition of this unique pattern of miliary tuberculosis is of important implications in clinical practice. Invasive diagnostic procedures should be attepmted if simple diagnosic methods failed to identify the etiology. |
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