Results of treatment of pneumoconiosis complicated by tuberculosis.

Abstract

Most patients who suffer from infectious pneumoconio tuberculosis die within a few years. Antituberculous chemotherapy has been found to be singularly ineffective in these patients. Most of the published studies have described little more than a palliative effect. This is in striking contrast to the almost invariable success with which patients with uncomplicated pulmonary tuberculosis can be treated. We report here on our experience, which suggests, contrary to other writers, that similar success can be obtained in patients suffering from advanced pneumoconiosis in addition to tuberculosis. The Patients Selection of Cases.?There were in all 29 cases of pneumoconiosis complicated by tuberculosis treated in Bangour Hospital, West Lothian ; Southfield Hospital, and the City Hospital, Edinburgh, between 1953 and 1958. Of these, one was excluded because he had left the district and could not be traced. Three others were also excluded because they had only recently come under observation. Otherwise there have been no exclusions. There remained, therefore, 25 patients for analysis. Diagnosis.?Of these 25 patients, 17 were coal-miners with anthracotuberculosis, and the remaining eight suffered from silicotuberculosis. Tubercle bacilli were cultured from sputum in each case, and in most cases were found on direct smear as well. Twenty-four of the patients had been awarded pensions by the Pneumoconiosis Medical Panel of the Ministry of Pensions and National Insurance. The remaining patient had not applied for a pension. Age.?The patients' ages ranged from 44 to 79 years, the average being 59.3 years. Duration of Exposure to Dust.?This ranged from 16 to 63 years (average 35.9 years). Exposure was longer in coal-miners (average 41.1 years) than in workers exposed to siliceous dust (average 25.0 years). Radiological Appearance on Diagnosis.?Eighteen cases were classified as breaking-down progressive massive fibrosis, while the remaining seven were classified as unmodified tuberculosis on a background of simple pneumoconiosis. The differentiation between these two groups was not easy except in those cases where jc-ray films were available before the development of tuberculosis. Otherwise weight was given to the density of the pulmonary opacities, the presence or absence of distortion of the pulmonary architecture by fibrosis, the occurrence of inky-black sputum, and the radiological response to treatment. The categories of pneumoconiosis (Fletcher, 1955) were: Simple .7 Progressive massive fibrosis. Category A ... 2 B ... 4 C ? D9 Categories A to D indicate increasing degrees of severity. Most cases therefore had very extensive disease. Sensitivity of M. tuberculosis.?In every case sensitivity of the patient's organisms was determined towards /rara-aminosalicylic acid (P.A.S.), streptomycin, and isoniazid at the beginning of treatment. One case showed initial resistance to streptomycin (ratio>16). All the other cases showed sensitivity to the three drugs ?that is, sensitivity ratios of up to and including two for streptomycin, up to four for P.A.S., and for isoniazid a growth of less than 20 colonies in a concentration of 0.2 fig. of isoniazid per ml.