[Complications in tuberculous patients--with special reference to secondary mixed infections]

An attempt was made to elucidate the mechanism which makes pulmonary tuberculosis intractable. Patients with pulmonary tuberculosis were divided into the following two groups; one group consisted of patients (n = 37) in which tubercle bacilli converted to negative within 6 months after the institution of anti-tuberculous chemotherapy and remained negative thereafter, and the other group (n = 21) in which tubercle bacilli persisted in spite of long-term chemotherapy. A comparison was made on serum factors and blood cell components, which were linked with humoral and cellular immunity respectively, between the above two groups of tuberculosis patients. As the result, reductions was observed in the ratio of serum albumin to globulin and increase in erythrocytes sedimentation rate and in amount of immunosuppressive acidic proteins in the chronic bacillary cases as compared with the patients in which negative conversion of bacilli had been achieved. A depressed cellular immunity was also found in the former group of the patients as evidenced with the reduction in a ratio of helper/inducer T lymphocytes to suppressor/cytotoxic T lymphocytes and in intensity of skin reaction to PPD. The depressed humoral and cellular immunity observed in chronic bacillary cases were one of possible causes of intractability of the disease and also the major cause of the frequent involvement with pulmonary infections with pathogens other than tubercle bacilli. At the second part, a problem in treating patients with both lung cancer and pulmonary tuberculosis was discussed, since iatrogenic immunosuppression was induced almost unavoidably by the use of anticancer agents.(ABSTRACT TRUNCATED AT 250 WORDS)