[Four cases of simultaneous discovery of familial tuberculous infection]

Index case is a 17-year-old boy who was admitted to our hospital with pleurisy and a minimal pulmonary lesion, and tubercle bacilli were recovered from pleural fluid. A diagnosis of primary tuberculosis was made based on the onset by pleurisy and the existence of hilar and mediastinal lymph node swelling. On the same day, a 76-year-old man, grandfather of the index case was admitted for precise examination of suspected extensive pneumonia. Tubercle bacilli were also isolated from the pus of infected bulla obtained by puncture. Neither of these two cases, however, seemed to be the source of the familial tuberculous infection because of such sudden onset of the disease as pleurisy and pneumonia. Two months later, a 46-year-old man, father of the index case was examined at our hospital. He was considered to be the source of the familial infection because he was diagnosed as tuberculosis with positive smear and a thick wall cavity (3.2 cm in diameter) on the left apex, and abnormal shadow was detected on his chest X-ray already two years ago. The fourth case was a mother of the index case, and wife of the third case, whose chest radiography revealed an infiltrative shadow on the right apex by a family contacts examination. Though tubercle bacilli were not isolated from her sputum, pulmonary lesions considered to be tuberculosis due to their typical location and nature, a positive PPD skin test, and the response to antituberculous drugs.