STUDIES ON AGGRAVATION OF PULMONARY TUBERCULOSIS

Observation on Newly appeared Shadows in Chest X-ray

Abstract

Although the prognosis of pulmonary tuberculosis has become fairly good with the recent development of antituberculous agents, there have been still a few number of patients who showed aggravation during the treatment or relapse after discontinuation of antituberculous therapy. The criteria of aggravation and relapse, however is so far not clearly defined, and discrepancy is seen among various research workers.
In this paper, 1, 024 patients with pulmonary tuberculosis who has/had been admitted to the nine institutions in both Nagasaki and Saga Prefectures during the period from January 1970 to March 1976 were surveyed and the patients showing roentgenologically new shadows were mainly analysed in relation to the differential diagnosis between bacterial infections and true tuberculous aggravations. Moreover, patients with reappearance of A. F. B. in sputum after consecutive three months negative cultures were investigated.
The results were as follows:
1) Seventy (6.8%) out of 1, 024 patients surveyed developed “new shadows” on chest X-ray, i. e. enlargement of shadow (4a according to the Gakken Standard) 24, appearance of new shadows (4b) 27, cavitation (4c) 16, and development of pleural effusion (4d) 3.
2) Sixteen (22.3%) out of 70 patients with development of new shadows seemed to have ordinary bacterial infection (bacterial pneumonia). Most of these patients had high fever of more than 38°C at the onset of infection and the laboratory examination revealed leukocytosis with the shift to left, accelerated ESR, positive CRP and increased mucoprotein. Escherichia coli and Pseudomonas aeruginosa were isolated from each two patients and Staphylococcus aureus was from one patient. No remarkable pathogenic organisms were detected from the sputum of the remaining 11 patients.
These shadows disappeared within two months by antibacterial drug's treatment in all 16 cases. Hence, it is suggested to set the two-month observation period as target for differential diagnosis between bacterial pneumonia and aggravation of pulmonary tuberculosis. It was also found that the tuberculous patient with low pulmonary function were easily infected by pyogenic organisms.
3) Seven patients showing cavitation of tuberculoma without enlargement of shadows had good clinical course, but almost all the patients with cavitation accompanyed with enlargement of shadows showed no improvement even after 6 months treatment.
4) From the above mentioned results, it is questionable to judge the cavitation without enlargement of shadows on roentgenogram or the appearance of new shadows as aggravation of pulmonary tuberculosis according to the present Gakken Standard for Evaluation of Course of Pulmonary Tuberculosis, and the cavitation without enlargement of shadows and the appearance of new shadows which disappears within two months could be excluded from the aggravation of tuberculosis.