Chemotherapy in a Cairo Chest Clinic: A preliminary report on the methods adopted in assessing the value of izoniazid, streptomycin and paraminosalicylic acid in 122 cases of pulmonary tuberculosis

Abstract

The results of chemotherapy in a group of 122 patients attending a chest clinic in the city of Cairo are presented. The reasons for advocating this innovation into dispensary practice in Egypt are given, and special reference is made to the extremely limited institutional accommodation in the country. During this trial no sensitivity testing or sputum culture facilities were possible, though this defect has since been remedied by co-operation between the Egyptian Government and WHO. The classificaiton used for patients under treatment is that recommended by the Expert Committee to the World Health Organisation, but which has not been widely adopted. It conforms to a modified code-system in which objective evidence of radiological signs and sputum examination are the two most important features. The cases are divided into tree groups: (a)) Cases with lesions on one or both sides of the chest with no suspicion of cavity formation; (a)) cases with lesions on one or both sides of the chest with suspicion of cavity formation; and (c)) cases with lesions on one or both sides of the chest with definite evidence of cavity formation. In the combined groups, radiological improvement was noted in 87 cases (71 per cent.); weight increase in 76 cases (62 per cent.); the general condition improved in 92 (75 cer cent.), and diminution in the bacillary count resulted in 42 cases (34 per cent.). Conversion of sputum was noted in 26 cases out of a total of 63 with positive sputa at the beginning of the trial (40 per cent.). No symptoms of toxicity were observed during the trial. A follow-up of 71 cases included in the first part of the study was made, and the difficulties associated with such a follow-up are described. The complete period of observation of these cases was from nine to thirteen months. Radiological improvement continued in 81 per cent., sputum conversion was maintained in 13 per cent., the bacillary count was reduced in 70 per cent., and weight increase and improvement in the general condition ranged from 70 to 80 per cent. It is concluded that, however much the findings may fall short of the ideal, there seems little doubt that they are in advance of what appertained in this country prior to the advent of chemotherapy. Good home-visiting services and supervision during the period of treatment are even more necessary in Cairo than in many other large centres of population. Chemotherapy must always be associated with an effective chest clinic practice, and never be regarded as a substitute for essential measures in tuberculosis control.