Abstract: Objective: To analyze the characteristics of pulmonary tuberculosis (PTB) patients and diagnosis and referral in respiratory wards of general hospital, in order to provide help for early detection of PTB patients and referral to tuberculosis (TB) prevention and control institutions. Methods: A total of 68 PTB patients (including presumptive cases, clinically diagnosed cases and confirmed cases) diagnosed in the respiratory wards of Beijing Luhe Hospital from May 2018 to January 2020 were collected. After discharge, 57 cases were diagnosed as PTB (including clinical diagnosis and confirmed cases) in TB designated hospitals or TB control dispensaries. We descriptively analyzed data of 57 PTB patients, and compared them with the data of 114 cases with PTB related symptoms and excluding PTB diagnosis in the same period. Results: Among the 57 PTB patients, 33 were males and 24 were females, aged from 20 to 93 years old, and the proportion of patients ≥60 years old was the highest, accounting for 61.4% (35/57). The most common clinical symptoms were cough (51 cases, 89.5%), followed by expectoration (44 cases, 77.2%), chest tightness and shortness of breath (32 cases, 56.1%) and fatigue (30 cases, 52.6%). The main diagnosis on admission was pleural effusion (17 cases, 29.8%), pneumonia (16 cases, 28.1%) and lung shadow of unknown origin (15 cases, 26.3%), and the most common complication was hypoproteinemia (20 cases, 35.1%). The diagnosis of PTB mainly depended on acid-fast staining of specific bacteria (26 cases, 45.6%) and nucleic acid detection of Mycobacterium tuberculosis (24 cases, 42.1%). The positive rate of bronchoalveolar lavage fluid samples (91.3% (21/23)) was higher than that of sputum (19.6% (9/46)), tracheoscope brushes (17.1% (7/41)) and pleural effusion (10.0% (2/20)); Chest CT examination reported 3 cases of pulmonary tuberculosis, and the positive rate was 5.3%. The proportion of patient delay rate among PTB patients was 24.6% (14/57), while the proportion of diagnosis delay was 43.9% (25/57). Among the 68 patients discharged with PTB, 54 cases were referred to TB designated hospitals and finally confirmed, 3 cases were referred to TB control dispensaries and finally confirmed, 6 cases were referred to TB designated hospitals and excluded, 2 cases with mild symptoms were not referred to TB control dispensaries as required, 3 cases temporary visitors to Beijing were lost to follow up with unknown referral and diagnosis details. The comparison of two groups showed that patients with PTB had higher proportions of emaciation (33.3% (19/57)), chest pain (31.6% (18/57)), unilateral pleural effusion (45.6% (26/57)), pulmonary consolidation (33.3% (19/57)), tracheal stenosis (14.0% (8/57)) than those of control group (14.9% (17/114), 16.7% (19/114), 12.3% (14/114), 14.0% (16/114), 2.6% (3/114)), the differences were statistically significant (χ ²=12.108, P=0.001; χ ²=3.958, P=0.047; χ ²=23.561, P=0.000; χ ²=8.694, P=0.003; χ ²=23.561, P=0.008). Conclusion: PTB patients in respiratory wards of general hospital are mainly elderly people, the positive rate of PTB screened through chest CT images is low. Emaciation, chest pain, unilateral pleural effusion, intrapulmonary consolidation and tracheal stenosis etc. have certain reference value for clinical diagnosis.

Key words: Hospitals, general, Tuberculosis, pulmonary, Disease attributes, Comparative study