Perspectives in adolescent tuberculosis: three decades of experience

Three hundred seventy-one adolescents and young adults, 10 to 20 years of age, were treated for tuberculosis during a 29-year period. There were 258 patients tuberculin positive without disease, 37 with calcifications on chest roentgenographs, and 76 with active tuberculous disease. All patients received chemotherapy. Active tuberculosis was more common in the 10- to 12-year-old patients. The greater number of tuberculin reactors in this age group suggests that endocrine factors related to the onset of puberty may play a role in conversion. No significant sex difference was apparent. Drug toxicity was rarely a problem. Pregnancy subsequent to therapy was not associated with progression or reactivation of disease. Two (possibly three) patients who were properly treated and compliant with the drug regimen had reactivation disease 4 to 14 years later. Cavitary pulmonary disease occurred in the two compliant patients. Meningitis, believed to be tuberculous, occurred in the suspected case. Two of these received isoniazid prophylaxis for skin test conversion only. In one patient, treated with two drugs for primary tuberculosis in the past, tuberculous pneumonia developed later. All three recovered. Although reactivation does occur, it is rare. Because most tuberculin reactors were discovered in the 10- to 12-year age group when screened routinely in high school, this procedure should not be abandoned.