Smear-positive pulmonary tuberculosis diagnosed in a general hospital

In Japan, patients with smear-positive pulmonary tuberculosis (SPTB) are hospitalized in a sanatorium because of the law for the prevention of tuberculosis, and not in a general hospital. According to our experience, however, some of the patients with SPTB are hospitalized in a general hospital. In order to study if it is possible to prevent the admission of patients with SPTB to a general hospital, we retrospectively reviewed and compared the medical records of pulmonary TB patients whose sputum was smear-positive for Mycobacterium tuberculosis at our outpatient clinic (Group B; n = 61), and patients whose sputum was smear-positive after the admission to our hospital (Group A; n = 17). The Group A patients were significantly older than the Group B patients [mean age, Group A, 67 years vs Group B, 56 years; (p = 0.01)]. Compared with the Group B patients, the Group A patients more often suffered from underlying diseases [percentage of patients with underlying disease, Group A, 88.2% vs Group B, 37.7%; p < 0.001]; more often showed atypical infiltrative patterns of pulmonary tuberculosis [percentage of cases showing atypical chest roentgenograms, 70.6% vs 19.7%; p < 0.001]; and were in a more serious condition [percentage of deaths during treatment, 47.1% vs 1.7%; p < 0.001]. We conclude that hospitalization of SPTB patients in general hospitals is inevitable, because SPTB can not always be accurately diagnosed before admission, and because it is sometimes difficult to send severely ill SPTB patients to a sanatorium which is inconveniently located in the countryside. We propose to provide facilities for the treatment of SPTB at all general hospitals in Japan.