强直性脊柱炎延误诊断的初步调查和原因分析

目的 调查强直性脊柱炎(AS)延误诊断的情况和分析原因.方法 收集我院门诊或病房就诊的符合1984年修订纽约AS诊断标准的的308例AS患者,通过面对面和电话联系相结合方法,选择13个问题来搜集AS延误诊治的情况;并从误诊时的症状和检查等方面分析延误诊治的原因.结果 238/308例作出了全部问题的回应,其中,男女比例是6:1;①发病年龄:发病年龄<15岁占18.1%,15～39 岁占79.0%,≥40岁占2.9%,平均发病年龄是22.1岁.②男女患者平均确诊年龄分别是(28±8)岁和(31±10)岁;男女患者平均延迟诊断时间差异无统计学意义(P=0.135)③有AS家族患病史的有57例(占23.9%),有家族史的平均延迟诊断时间分别是73.2个月,无家族史的患者平均延迟诊断时间是71.9个月,两组比较差异无统计学意义(P=0.899).④人类白细胞抗原(HLA)-B27(+)占84.9%,HLA-B27(+)组和(-)组平均延迟诊断时间分别是70.1个月和88.1个月,两组比较差异均无统计学意义(p>0.05.但在延迟诊断>10年确诊的AS患者中,24例HLA-B27(+)和10例HLA-B27(-),两组比较差异有统计学义(P=0.012).⑤在238例患者中,误诊率为66.4%,平均延迟诊断时间是(72±68)个月.其中,单次误诊占45.0%,多次误诊的占21.4%,其中有7例延迟诊断≥10年却无出现误诊.最常误诊的疾病包括:与风湿热相关的关节炎(23.4%)、腰肌劳损(22.9%)和椎间盘突出(20.3%)等.结论 AS延误诊治可能与是否HLA-B27阳性和缺乏骶髂关节的X线资料密切相关.     

新发现老年人菌阳肺结核患者延误诊断的调查分析

目的探讨老年肺结核的误诊原因，提高老年肺结核的诊断水平。方法采用临床分析方法，对2003—2007年60岁以上收治误诊的102例老年肺结核病人进行分析。结果老年延误诊断患者79例（77．52％）；延误诊断的中位数是73．3天。医生延误的主要原因是误诊，病人延误的主要原因是未重视、误以为感冒不需看医生占68％。有56．9％的患者有合并症。结论老年肺结核临床特点不典型，合并症多，就诊和诊断延迟现象较为严重。应切实加强老年结核病防治工作，以便做到早期诊断、早期治疗。     

150例农村地区肺结核可疑症状者就诊情况分析

目的了解肺结核可疑症状者在县级及乡镇的就诊情况。方法在贵州省的8个乡镇选取150例肺结核可疑症状者进行问卷调查。结果到县级就诊“治疗的机会成本”是到乡镇的16.8倍,58.7％的可疑症状者选择基层医疗机构作为首诊单位,首诊延迟的患者占44.7％;只有30.7％的结核病人初次诊断在县级结防机构,16.7％的结核病人诊断延迟;在乡镇就诊的可疑症状者平均花费为149.13元,接受痰菌检查者占67.9％。结论乡镇查痰点方便病人就诊,但乡镇卫生院诊断水平相对低。非结防机构对肺结核病人的确诊延迟情况严重。     

新疆维吾尔自治区喀什地区肺结核就诊及确诊延迟调查分析

目的 分析新疆喀什地区肺结核患者就诊与确诊延迟的原因,为提高就诊和确诊的措施提供依据。 方法 对喀什地区除塔什库尔干县（高海拔偏远小县）外其他所有11个县（市）2005年1月1日至2010年9月30日登记的所有活动性肺结核患者43 832例（其中有7622例因出现症状至初次就诊日期填写不详而无法评价,占17.39%）就诊延迟和确诊延迟进行统计,结合每个县面对面问卷调查不少于20例2010年结束疗程的肺结核患者对防治结核病知识的认知、就医行为等进行调查分析;同时对被调查乡卫生院及村卫生室的状况进行调查了解。 结果 患者出现症状到第一次就诊平均间隔106.5 d,91.98%（33 305/36 210）就诊延迟;就诊前了解相关信息者延迟率为51.43%（18/35）,而不了解者为98.11%（52/53）,差异有统计学意义（χ²=28.24,P<0.01）;患者初诊至确诊平均间隔80.1 d,33.25%（12 102/36 393）确诊延迟;乡医院痰菌检出率为13.15%（43/327）、诊断符合率93.58%（306/327）;X线胸片合格率72.64%（146/201）、诊断符合率76.03%（111/146）;村医无诊断结核病的能力。 结论 就诊延迟和确诊延迟现象在喀什地区农村中普遍存在。强化少数民族人口结核病防治策略和措施的宣传,提高乡村级诊断能力和转送意识,是当前喀什地区亟待解决的问题。     

泌尿系统结核29例临床分析

目的总结泌尿系统结核的临床特点。方法回顾性分析1998年12月31日—2008年12月31日在中山大学附属第二医院住院的泌尿系统结核患者的临床资料。记录患者的一般情况、既往病史、临床表现、实验室检查、影像学检查及诊断和误诊情况。结果10年间共收集泌尿系统结核患者29例,肾脏受累者24例（占82．8％）,输尿管受累者11例（占37．9％）,膀胱受累者3例（占10．3％）。合并肺结核9例,泌尿系统以外的肺外结核5例,存在免疫功能受损者10例。常见临床特征包括膀胱刺激征18例（占62．1％）,腰痛17例（占58．6％）,白细胞尿14例（占48．3％）及血尿14例（占48．3％）。经病理学检查确诊22例,经病原学检查确诊5例,经诊断性治疗确诊2例。初次就诊至确诊的时间中位数为4个月（0～10年）。结论对于存在肺结核及其他部位肺外结核的成年患者,出现一般抗感染治疗无反应的慢性膀胱炎或无菌性脓尿时,应高度怀疑泌尿系统结核的可能。宜及早行静脉肾盂造影（IVP）或电子计算机断层扫描（CT）检查,反复尿沉渣涂片抗酸染色、结核菌培养、结核菌聚合酶链反应（PCR）检查有助于泌尿系统结核的早期诊断。     

新发涂阳肺结核患者各类延误水平相关指标的探讨

目的 探讨并评价患者各类延误需采取的指标、数据收集方法及其可行性,为制定减少延误发生的干预措施提供科学依据。方法 根据患者就医过程中的关键节点（出现症状、首次就诊、确诊结核病和开始治疗）定义了与延误相关的不同指标,包括总延误、就诊延误、诊断延误和治疗延误等;采取典型调查的方法,分别在东、中、西部各选择1个县（共3个县）作为研究现场,使用编制的《新发涂阳肺结核患者诊疗过程调查表》对研究现场的结核病防治（简称“结防”）机构2010年5-9月登记发现的初治涂阳肺结核患者进行面对面的问卷调查,共纳入患者329例。结果 患者中男性占81.5%（268/329）,平均年龄51.8岁(95% CI:49.9～53.8),农民占71.1%（234/329）,初中及以下文化程度者占86.6%（285/329）,年均纯收入低于5000元者占81.2%（267/329）;患者的总延误时间为36d(0～597d),就诊延误15d(0～594d),诊断延误10d(0～429d),就诊延误与诊断延误的差异无统计学意义(t=1.596, P=0.111);按照发生原因,结防机构因素导致的诊断延误为7d(0～428d),患者因素导致的诊断延误为1d(0～45d),两者间的差异有统计学意义(t=8.609, P=0.000);按照就医关键节点,结核病可疑者的发现延误为0d(0～428d),结核病可疑者的转诊延误为4d(0～267d),两者间的差异有统计学意义(t=3.235, P=0.001)。结论 使用该研究制定的延误指标可以更为深入地分析延误产生的原因。     

757例初治肺结核患者抗结核治疗效果影响因素分析

目的 了解初治肺结核的治疗动态并探讨影响其治疗效果的因素。 方法 以2009-2011年江苏省响水县疾病预防控制中心登记并随访管理的757例初治结核病患者作为研究对象,采用同时考虑事件结局、随访时间及截尾数据的生存分析模型进行单因素和多因素分析。 结果 757例患者中成功治疗720例,不良结果37例。Kaplan-Meier生存率曲线估计初治肺结核中位成功治疗时间为182 d,Log-rank单因素分析结果显示来源为转诊、因症就诊及其他途径患者的实际成功治疗数所占比例分别为24.17% (174/720),66.53% (479/720),9.31% (67/720),与各来源估计成功治疗比例分别为29.86%（215/720）,59.72%（430/720）,10.42%（75/720）之间分布差异具有统计学意义(χ²=23.19,P =0.000)。存在延迟与未存在延迟就诊患者的实际成功治疗数所占比例分别为26.67% (192/720)与73.33% (528/720),与延迟与否估计成功治疗比例 (31.25%,68.75%)之间分布差异具有统计学意义(χ²=11.33,P=0.001);Cox多因素分析显示45～岁（OR=1.213,95%CI=1.014～1.452）及≥60岁以上（OR=1.323,95%CI=1.069～1.636）年龄组的成功治疗率高于30岁以下,农民（OR=0.787,95%CI=0.650～0.953）及其他职业者(OR=0.755,95%CI=0.591～0.966)成功治疗率低于工人,因症就诊（OR=1.498,95%CI=1.275～1.760）的成功治疗率高于转诊患者,延迟就诊（OR=0.782,95%CI=0.658～0.929）的成功治疗率低于非延迟者。 结论 在当地肺结核初治过程中,应加强对农民、30岁以下年龄段、转诊来源及存在延迟就诊的患者的治疗管理。     

妊娠肺结核延误诊断分析

目的：了解临床妊娠肺结核诊断延误情况。方法：对1997年1月-2001年12月我所住院妊娠肺结核患者诊断延误原因进行临床回顾性分析。结果：25例妊娠妇女因症就诊者16例（64％），未就诊者9例（36％），延误诊断中位时间6周。结论：延误诊断原因是顾虑胸部X线对胎儿的影响放弃检查；害怕药物治疗影响胎儿；结核病症状误为妊娠反应；因肺外结核误诊。     

2000—2009年天津市监狱系统在押犯人中结核病患者发现情况分析

摘要：目的 了解天津市监狱系统在押犯人中结核病患者发现情况和变动趋势。方法 天津市结核病控制中心自2000年起对监狱系统在押犯人采取入监体检、普查和因症就诊相结合的方式,2000-2009年间确诊结核患者1811例。收集这10年间监狱结核患者登记资料,对结核患者发现方式、发病特征及其变动趋势进行分析。 结果 1811例患者中,涂阳肺结核占9.7%(176/1811),涂阴肺结核占82.9%(1502/1811),结核性胸膜炎占7.3%(133/1811);以男性和青壮年占多数,男性占98.3%(1780/1811),25~54岁患者占84.0%（1522/1811）。复治患者比例由2000年的39.0%(144/369),至2009年下降至3.3%(7/211);患者发现方式看,普查所占比例由2001年时占70.2%(207/295),至2009年下降至19.4%(41/211);入监体检和因症就诊比例2001年分别占7.5%(22/295)和22.4%(66/295),至2009年分别上升至38.4%(81/211)和42.2%(89/211);具有肺结核主要症状（咳嗽、咯痰≥2周或咯血、血痰）的患者所占比例2000年56.9%,至2009年下降至28.4%;因症就诊患者平均就诊延误时间2000年为38.38 d,至2009年缩短至8.41 d。 结论 监狱患者的发现以入监体检、普查和因症就诊为主,10年间普查所占比例下降,入监体检和因症就诊所占比例升高;复治比例和具有肺结核主要症状者比例下降;因症就诊患者就诊延误时间缩短。证明监狱结核患者发现更为及时,患者发现取得良好效果,今后监狱系统结核病控制工作还应该坚持3种方式相结合的患者发现方法。     

146例儿童结核病延误诊断原因分析

本文对146例儿童结核病延误诊断原因进行分析,结果发现延误诊断与首诊医师及就诊单位直接有关。延误天数15至296天,平均41.8天。医生延误129例(88.36％),患者延误17例(11.64％)。首诊于诊所及综合医院125例(85.62％),误诊病种达14种,包括肺炎75例(51.37％)、感冒28例(19.18％),化脓性脑膜炎10例(6.85％),病毒性脑膜炎7例(4.79％)等。未行X线检查者94例(64.38％),咳痰而未行结核菌检查者43例(68.25％,43/63),未行结素试验或结果不明者74例(50.68％),因此,加强首诊医师负责制,提高综合医院医师对儿童结核病的认识,完善实验室检查,有助于缩短延误诊断时间。     

The current status and problems of the intestinal tuberculosis through a review of the Annual of the Pathological Autopsy Cases in Japan

From 1997 to 1999 the incidence rate of tuberculosis increased and extrapulmonary tuberculosis has also increased during the same period. Among various types of extrapulmonary tuberculosis, intestinal tuberculosis is one of the diseases difficult to diagnose. Recently doctors could not make appropriate diagnosis of intestinal tuberculosis because they did not pay much attention to tuberculosis. With a background described above, we reviewed the Annual of the Pathological Autopsy Cases in Japan in previous five years 1994-1998, in order to investigate a current status of intestinal tuberculosis. Out of 140,358 autopsied cases, the number of cases with active and old tuberculosis was 5,103 (3.6%), in which the intestinal tuberculosis was accompanied in 80 (0.057%). The 80 cases were consisting of 45 males and 35 females and their mean age was 72.7 years old ranging from 28 to 96. Of the 80 intestinal tuberculosis cases, 71 were seen in pulmonary tuberculosis cases and six cases were considered to be intestinal tuberculosis alone. In terms of the location of intestinal tuberculosis the most commonly affected site was ileocecum which occupied 72.7% of all intestinal tuberculosis. Among the 80 cases, 14 cases were complicated with malignant tumor and only 30 cases (37.5%) were diagnosed clinically as intestinal tuberculosis before their death. Clinical diagnosis of other cases were ileus, simple constipation, severe diarrhea, malignant tumor or its tumor. The delay in diagnosing intestinal tuberculosis may result in fatal outcome in the aged persons, so that in general practice much attention should be paid not only to pulmonary but also extrapulmonary tuberculosis including intestinal tuberculosis.     

Diagnosis of pulmonary tuberculosis in general hospital "a study of 114 cases"]

We conducted a study on the diagnosis of pulmonary tuberculosis at Chiba Kaihin Municipal Hospital. Examinations were performed to determine the presence of active Mycobacterium tuberculosis in sputum and gastric aspirate. For the sputum smear-negative cases, fiberoptic bronchoscopy was further used as a means for detecting the tuberculosis. The results obtained were as follows: 1. A total of 114 cases in the past six years diagnosed as active pulmonary tuberculosis (including 88 primary treatment cases) were analysed. 2. The 114 cases consisted of 74 males and 40 females, the mean age was 49.3 years old. Categorically, the main age groups were: 60s, 24 cases; 30s, 21 cases; and 40s, 20 cases. 3. Chest X-ray findings: Cavitary cases were 28.9% GAKKAI classification of the sizes of the affected areas being Type 1 (mostly limited cases), 58.9% of all total cases, and 68.4% in the cases under the age of 50 years old. The number of cases having infection in a solitary nodule was 19, and the ages of 15 out of the 19 patients were under 50 years old. 4. Sputum or gastric aspirate smear-positive cases totalled 37 (32.5%), and culture-positive cases totalled 77 (67.5%). Sputum or gastric aspirate cultures were positive in 52 out of 56 cases (92.9%) with extended shadows, GAKKAI classification Types 2 and 3, but were positive in 25 out of 58 cases (43.1%) with Type 1. 5. Fiberoptic bronchoscopy was performed on 49 out of the 77 smear-negative cases. 6. Definite diagnosis was obtained in 90 (78.8%) out of total 114 cases. The results of this study suggest that examination for active mycobacterium in sputum and gastric aspirate are very useful for the diagnosis of active pulmonary tuberculosis, especially in extended cases.     

肺结核并发肺栓塞的诊断与治疗

目的探讨肺结核并发肺栓塞(pulmonary embolism,PE)的诊断与治疗方法。方法分析2002年6月—2005年6月诊治的5例肺结核并发PE病例的临床资料。结果5例患者肺结核并发PE后,咳嗽、咳痰、发热加重,并出现胸闷、胸痛、心悸、呼吸困难,查体为呼吸急促、心动过速。经多普勒超声心动图、螺旋CT肺动脉造影检查明确PE诊断。5例确诊时间均已超过溶栓时间,其中1例转外科手术治疗后应用抗凝药物治疗,余4例均给予抗结核治疗同时抗凝治疗。其中1例未坚持服用抗凝药物,2年后再次复发PE抢救无效死亡,余4例病情好转。结论肺结核可并发PE,因临床症状类似,易延误诊断,错过溶栓时间,PE诊断以影像学检查为主,抗凝治疗是最佳治疗方法。     

Preventable tuberculosis cases in Japan--a new approach to the assessment of tuberculosis control problems

I defined cases of tuberculosis which could not be prevented from infection or development of disease among infected, or could not be detected in the early stages as "preventable cases" in order to evaluate tuberculosis control efforts in the community, Japan. Among 241 bacteriologically confirmed cases with pulmonary tuberculosis newly registered from 1988 through 1989 in Yamagata Prefecture, 80 (33%) were defined as preventable cases by observing their course and the process of diagnosis. That is to say, one-third of bacillary cases could have been prevented in Yamagata where the incidence of tuberculosis was lowest in Japan, if existing prevention and control methods had been effectively used. Causes of prevention failure were investigated in detail. The most common cause was tardy detection of cases, especially due to delayed confirmation of diagnosis (so called "doctor's delay"). The delayed confirmation of diagnosis resulted from neglecting chest X-ray and sputum examination and from ignoring high risk groups. In the younger age group, it was mainly attributed to insufficient family contact examinations. Tuberculin skin tests are necessary not only for those aged 15 years and younger but also for those aged 16-29, when they are found to be household contacts of smear-positive cases. An evaluation of tuberculosis control program defining preventable cases would be a beneficial approach to the surveillance of tuberculosis.     

A subset of clinical status of pulmonary tuberculosis in Southern Taiwan

The aims of this study were to present the clinical status of pulmonary tuberculosis in Southern Taiwan and to analyze the reasons for failure of antituberculosis treatment in order to achieve a higher rate of success after treatment. Two hundred and senventeen adult patients, aged 15 to 90 years old who presented to the Chest Division, Kaohsiung Medical University Hospital from 1999 to 2002 with a diagnosis of Pulmonary Tuberculosis, were retrospectively studied. We compared the rate of recurrence of pulmonary tuberculosis by dividing the cases into 2 groups: those who completed treatment and those who did not. We also determined the age distributions for when initial diagnosis of pulmonary tuberculosis was made among these 217 cases. In 90 culture proven cases, antituberculosis drug susceptibility was tested to determine the rate of drug resistance. We also assessed the reasons for failure of treatment. Age distribution analysis showed that initial infection began at a young age, was widely spread, and occurred regardless of age. There were 116 cases that completed antituberculosis treatment and 101 cases that did not. Of the 116 cases, only 16 relapsed, whereas 79 of the 101 cases relapsed. In cases where completely treated patients relapsed, the period before recurrence was indefinite. Most of the cases of incompletely treated patients relapsed earlier. In the 90 culture proven cases in which antituberculosis drug susceptibility was tested, 39 patients showed resistance to at least one drug, 9 patients were resistant to only one drug, 9 patients were resistant to two drugs and 21 patients were resistant to more than 3 drugs. The common reasons for failure of treatments were: 1) poor patient compliance to medication: 50 cases, 2) multiple drug resistance: 30 cases, 3) delayed treatment: 19 cases. Some cases included a combination of the above.     

脾脏结核的CT影像表现

目的　探讨脾脏结核的CT影像表现及其诊断价值。方法 回顾分析临床证实的 25例脾脏结核的CT表现,其中男性 15例,女性 10例,年龄 16～ 52岁,中位年龄 25岁。结果 25例脾脏结核CT表现分为脓肿型、粟粒型、混合型和陈旧钙化型。平扫病灶模糊不清,增强后病灶显示清楚,但边缘显示不规则。结论 患者脾脏CT影像具有典型表现,年龄较轻且合并有肺结核病或/和其他肺外结核时,应考虑脾脏结核。     

惠州市不同年龄段肺结核患者耐药情况分析

目的分析惠州市不同年龄段肺结核患者耐药情况,为耐药肺结核的诊断与治疗提供参考依据。方法抽取2010—2013年惠州市结核病防治研究所结核科收治的肺结核患者1 484例,按照年龄分为18~35岁组356例,36~59岁组612例,≥60岁组516例。回顾性分析3组患者一线抗结核药物耐药情况及耐多药情况。结果 18~35岁组患者异烟肼(INH)和链霉素(SM)耐药率均高于36~59岁组,INH、利福平(RFP)、SM、乙胺丁醇(EMB)耐药率和总耐药率均高于≥60岁组(P0.05);36~59岁组患者RFP耐药率高于≥60岁组(P0.05)。18~35岁组患者耐多药率高于36~59岁组,耐3药、耐4药和耐多药率高于≥60岁组(P0.05)。结论惠州市不同年龄段肺结核患者耐药情况存在较大差异,青年患者容易形成获得性耐药,需采取有针对性的预防和监控措施。     

基于CT分型方法的儿童肺结核临床特征分析

目的 分析儿童肺结核CT特征的临床特点。方法 回顾性分析首都医科大学附属北京儿童医院2006年7月至2014年12月经临床诊断并确诊为肺结核的734例患儿的临床资料(包括年龄、性别、临床表现,疫苗接种史、接触史及实验室检查等),基于CT分型对其CT特征、临床特点进行分析。结果 734例患儿中159例(21.7%)为经病原学检测确诊;CT分型中原发性肺结核和气管、支气管结核最多见(365例,50.4%),并发2种及以上类型者次之(199例,27.3%);3岁以下婴幼儿以原发性肺结核和气管、支气管结核多见(189例,26.1%), 7~14岁青春期儿童以结核性胸膜炎多见(94例,13.0%);并发肺外结核患者以结核性脑膜炎(109例,34.5%)及肺外播散累及2个及以上器官或组织者(103例,32.6%)最多见。192例(26.2%)患儿并发其他疾病或患有基础疾病。结论 不同年龄阶段患儿的肺结核CT分型不同,且常并发肺外结核;儿童肺结核CT表现有其自身特点及年龄分布特点。     

A clinical study of causes of death from active pulmonary tuberculosis with chemotherapy

We evaluated retrospectively the causes of death from active pulmonary tuberculosis by the review of records and chest radiograohs of 364 patients (male 282, female 82) with active pulmonary tuberculosis, who were admitted to our hospital during 1995 to 1998. 43 patients (male 33, female 10) were died under anti-tuberculous chemotherapy. 20 cases were tuberculous death; death from acute progression of tuberculosis without response to chemotherapy (acute progression group) in eight cases and death from debility in spite of partial response to chemotherapy (debility group) in eight cases. 23 cases were died from underlying diseases; death from malignant neoplasmas (malignant group) in nine cases and death from complication of bacterial pneumonia (pneumonia group) in seven cases. In acute progression group, the age (mean +/- SE) was 64.8 +/- 5.2 years old and the survival period from admission was 11.8 +/- 4.2 days. Five cases were laborer or unemployed. This group was characterized with far advanced diseases presenting extensive lung lesions complicated with DIC or hepatic dysfunction, low performance status (PS), severe malnutrition and lymphocytepenia. In debility group, the age was 70.8 +/- 3.9 years old and the survival period from admission was 254.6 +/- 90.7 days. Five cases were laborer or unemployed. This group was characterized with multiple underlying diseases, low PS, previous anti-tuberculous chemotherapy and resistance to INH and/or RFP. In malignant group, the age was 69.3 +/- 3.2 years old and the survival period from admission was 99.9 +/- 21.2 days. This group was characterized with relatively well nourished, relatively good PS in comparison with other groups, and lymphocytepenia. In pneumonia group, the age was 82.8 +/- 1.7 years old and the survival period from admission was 153.3 +/- 54.5 days. This group was characterized with remarkably advanced age, low PS related to underlying disorders of central nervous system. In the causes of death with active pulmonary tuberculosis under chemotherapy, inhomogenous groups were included. Extensive disease, low PS, malnutrition, lymphocytopenia, previous chemotherapy, resistance to INH and/or RFP, and poorer social circumstances seemed to be risk factors for tuberculous death. In contrast, underlying malignant nepolasma, lower PS, and far advanced age were seemed to be the risk factors for non-tuberculous death.     

Study on the pulmonary tuberculosis in the elderly

A study was made for 13 cases of patients over 80 years of age who received medical treatment for tuberculosis. Four factors of onset of tuberculosis at old age were indicated. 1. No opportunity for examination of X-ray for old generation. 2. Atypical shadows on the chest X-ray film. 3. Low stress tolerance. 4. Exacerbation of old tuberculosis during the treatment of other diseases. The results suggest the possibility of increasing pulmonary tuberculosis among the elderly persons in the near future.