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The percentage of E-rosette forming T-lymphocytes is considerably decreased in a number of patients with severe form of lung tuberculosis, particularly in those with tuberculous empyema of the pleura (28.5% to 38%). After in vitro incubation of lymphocytes from those patients with thymosin V fraction T-lymphocytes restored normal.
This report is a case study of a vagrant whose state of tuberculosis showed noteworthy improvement due to clinical treatment. A 54-year-old male, vagrant, was admitted to the hospital in a state of preshock because of a serious stage of lung tuberculosis. The clinical course was severe, but after three months of intensive care the patient recovered. It was noted that the echocardiogram taken after recovery revealed improvement when compared with the one taken upon admission, which showed remarkable right ventricular overload. Furthermore, anti-tuberculosis agents proved to be very effective in this case. The patients respiratory functions improved more markedly than had been expected. The reason for reporting this case study is to bring attention to the improvements in the patient's clinical course and echocardiographic findings. These suggest that tuberculosis in vagrants may differ from the usual stage of tuberculosis diagnosed in elderly persons in terms of response to anti-tuberculosis agents and potential recovery.
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Artificial pneumothorax (APT) was the first positive treatment of tuberculosis to cause improvement. As a basic of therapy after 1910 it was replaced by chemotherapy 30 years later. Its development followed an early 19th century observation that spontaneous pneumothorax improved a tuberculosis patient. In 1822 James Carson originated the concept and principles of inducing a collapse after discovering the elasticity of the lungs in animal experiments. He also defined the limits of animal tolerance in induction by open chest incision, but failed in his only clinical attempt at an APT. Fornalini in 1984 independently revived the concept of APT using the closed method of needle induction, as later accepted. The principles of APT promoted thoracic surgery with the concept of permanent collapse in thoracoplasty; the experience of the management of postoperative shock in turn benefited the development of lung resection.
The mortality rate of WLTB was significantly higher than non-WLTB in 45 of 516 cases of PTB in a 24-month period. There is no known underlying disease predisposing to WLTB. Clinically, the patients were significantly more toxic and had lower serum albumin and hemoglobin levels than non-WLTB patients. They had a lower rate of positive PPD tuberculin skin tests. The chest roentgenograms revealed three patterns: (1) DBS type in 15--all with multiple or diffuse opacities with or without cavitations; (2) DHS type in 20--eight with typical miliary lesions and 12 with atypical miliary patterns; (3) combined focal PTB and DHS type in ten. We found that atypical chest roentgenographic patterns were common in WLTB and frequently led to misdiagnosis. The delayed diagnosis and treatment of this advanced disease resulted in the high mortality. Early, empirical antituberculosis chemotherapy is indicated and life-saving.
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In patients with pulmonary tuberculosis serum immunoglobulin levels are found to be increased, quantitative deviations from the norm are observed on analysis of the mononuclear cells, there is an increase in the number of circulating immune complexes, and, in the event of extensive pulmonary involvement, an attenuation of cell-mediated cutaneous reactions is seen. In accordance with the chronic course of the disease, a return to normalcy of these parameters in the healing phase occurs only gradually.
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