Immunological studies were carried out on patients with intractable pulmonary tuberculosis to evaluate the background factors of intractability.
Twenty-one cases who failed to convert to bacilli negative by previous treatment and who had the F (far advanced cavitary) type of
Gakken
classification on chest X-ray film were designated as intractable pulmonary tuberculous patients. The controls were twenty-seven cases of tractable pulmonary tuberculosis with negative bacilli and BC (cases infiltrative) type of
Gakken
classification, and a group of healthy subjects. In comparison with the controls, the intractable pulmonary tuberculosis patients showed the following characteristics: (1) A depression of the delayed type hypersensitivity (DTH) reaction to dinitrochlorobenzen (DNCB), (2) A decrease in the number of monocytes and lymphocytes in peripheral blood, (3) A depression in the interaction between monocytes and lymphocytes, (4) A decrease in the number of T-lymphocytes and early T-lymphocytes, and (5) An increase in the number of IgG-FcR
(+) T-lymphocytes. On the other hand, the number of B-lymphocytes and IgM-FcR
(+) T-lymphocytes, immunoglobulin levels in peripheral blood, and DTH to PPD were similar to those of the controls. Monocyte functions were almost the same as in the controls with respect to phagocytosis, nitroblue tetrazolium (NBT) reduction test, and lysosomal enzyme levels.
These results suggest that non-specific immunity of intractable pulmonary tuberculosis patients is depressed in cell-mediated immunity, but not in humoral immunity.
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