A study of causes of death among patients with active pulmonary tuberculosis from the standpoint of host factors

Abstract

To clarify the clinical features of fatal cases of active pulmonary tuberculosis, 36 patients with sputum positive for tubercle bacilli on admission were examined retrospectively. They were divided into two groups, those who died of tuberculosis (Group I), and those who died of non-tuberculous diseases (Group II). The mean age of all the patients was 74.8 years, and the male: female ratio was 7 : 3. In Group I (n = 26), the direct causes of death were respiratory failure (35%), general weakness (27%) and acute progression of tuberculosis (31%), and in Group II (n = 10), about half of the patients died of neoplasms. In addition, a control group (Group III) (n = 27) of patients matched for age and sex with Group I, was examined. They were tuberculous patients who had improved and were subsequently discharged after chemotherapy. Compared with Group III, more patients in Group I showed poor oral feeding and had been bedridden on admission. Their nutritional status was significantly poorer, based on determination of total serum protein, albumin, total serum cholesterol, and hemoglobin. With respect to cell-mediated immunity, Group I patients showed significantly lower peripheral lymphocyte counts and a reduced PPD skin reaction. However, the disease was more serious in Group I than in the control. It was suggested that patients subsequently died of active pulmonary tuberculosis showed not only serious illness, but also malnutrition and depressed cell-mediated immunity.