Immunological and clinical features of smear-positive pulmonary tuberculosis in East Java

The immunological and clinical features of 90 Javanese patients with smear -positive pulmonary tuberculosis were investigated. Many of the patients had advanced disease at the time of diagnosis and haemoptysis was common, especially in patients with cavitating lesions. Most patients had a significant elevation of one or more non-specific indicators of inflammation (erythrocyte sedimentation rate, third complement component, factor B and C-reactive protein). Rheumatoid factor was detected in 21% of the patients and was significantly associated with high levels of antibodies to M. tuberculosis in the IgM class. Five distinct responses were elicited by tuberculin testing; the most marked occurred at 24 hours. The degree of reaction at 6-8 hours correlated significantly with the levels of specific antibodies in the IgG and IgA classes and the 48 hour response correlated, although less markedly, with specific antibodies in the IgG class. Neither the degree of skin test reactivity nor the level of specific antimycobacterial antibodies correlated with the extent of disease as assessed radiologically. Nine per cent of the patients were skin-test negative at 48 hours but did not differ clinically, as a group, from tuberculin positive patients. It was not possible to place the cases in a spectrum of immunological responses similar to that occurring in leprosy and it is postulated that this is due to differences in the relevance to protection of the various immunological mechanisms in the two diseases. The need to establish more rigorous criteria for assessing the immune responses in tuberculosis and for studying the interactions between the protective and non-protective reactions is stressed.