1989 Volume 64 Issue 8 Pages 529-536
We studied tuberculin reactivity and clinical course after starting chemotherapy inpatients with active pulmonary tuberculosis divided by four age-groups less than 29, 30-49, 50-69 and 70 years and more.
The skin test to tuberculin purified protein derivative (PPD) was examined in 178 cases of active pulmonary tuberculosis, 120 cases of lung cancer, 25 cases of atypical mycobacteriosis and 466 cases of the other respiratory diseases.
Theaverage size of tuberculin reaction in pulmonary tuberculosis decreased with age, butsignificantly higher than that in patients with other nontuberculous pulmonary diseases ofthe same age-group.
The size of PPD skin test in the group of 70 years and more wassignificantly lower than other age-groups in pulmonary tuberculosis.
We compared thetime required for negative conversion of sputum by culture after primary chemotherapyamong the different age-groups in pulmonary tuberculosis.
It revealed that the time fornegative conversion tended to be longer with age, and the time in the group 70 years andmore was significantly longer than that of the group less than 29 years of age, although nosignificant differences in the radiographic severity and conditions of chemotherapy wereobserved. Finally, the PPD-induced lymphocyte proliferation test in vitro was done innewly diagnosed patients with pulmonary tuberculosis.
The patients were divided into twogroups by the size of PPD skin test (high responder more than 16 mm and low responderless than 15 mm of erythema induced by PPD).
The in vitro reactivity of peripheral bloodlymphocytes to PPD in both groups was examined by analysis of lymphocyte subsets bymonoclonal antibodies and flow cytometry.
A good correlation was shown betweenin vitro and in vivo reactivity to PPD.
The patients in the group of low responderfrequently showed a delay of improvement of tuberculosis during chemotherapy.
These results indicate that the elderly patients with pulmonary tuberculosis frequentlyshow a decrease of cellular immunity and a delay of improvement of disease.
