The course of fever during treatment of pulmonary tuberculosis

We studied 161 patients with pulmonary tuberculosis: 55 (34%) were afebrile and 106 (66%) were febrile at presentation. Febrile patients were younger and more symptomatic than afebrile individuals. Fever was also associated with a higher incidence of lymphopenia, hyponatraemia, hypoalbuminaemia and many acid-fast bacilli on sputum smear. Most patients were treated with isoniazid, rifampicin and pyrazinamide. Of 83 individuals who became afebrile while in hospital, 74 (89%) did so within a week and 77 (93%) in 2 weeks. Prolonged fever was associated with alcoholism, anaemia, hyponatraemia and hypoalbuminaemia. A therapeutic trial of antituberculosis drugs may be more useful than has been previously thought, since in most patients the temperature falls to normal within 2 weeks.