Primary Tuberculous Infection Research Articles

Tuberculosis in Pediatric Practice

Complete eradication of tuberculosis as a major cause of illness and death in the United States within the next generation or two is an attainable possibility by application of methods already known. If streptomycin or a similar drug proves efficacious this time would be considerably shortened. In the over-all fight against the disease the physician whose practice deals with children can contribute much in this final drive. Diagnostic tuberculin is one of the most specific of all the specific tests available for the detection of disease. The physician should use it routinely in his child patients at two to three year intervals. False negative tests occur only rarely. A positive test means only that a primary tuberculous infection has occurred at some previous time. However, the finding of a positive reaction in a child, especially a young child in the first years of life, may be the means of uncovering an hitherto unsuspected source of contagion. Furthermore, a positive test in a child identifies the individual who must be kept under observation for the possible development of chronic pulmonary tuberculosis at some future date. Mass x-raying the chests of children fails to make this distinction. Knowledge of the pathogenetic development of the various forms of tuberculosis aids the physician in recognizing the stage in the evolutionary course of the disease at which his patient may have arrived. There are fundamental differences between primary tuberculosis and reinfection tuberculosis. The development of tuberculoallergy several weeks after the initial infection is responsible for these differences. In the majority of children primary tuberculosis is limited to the pneumonic lesion and to the lymph node lesion. In a few, extension may occur by contiguity about the pulmonary focus, or by hematogenous or bronchogenic spread from the lymphnode focus. Thus accounted for are the acute reinfection forms of tuberculosis such as tuberculous broncho-pneumonia, miliary tuberculosis, and tuberculous meningitis. The latter, however, is not the direct result of hematogenous seeding, but rather, results from rupture of an older focus into the sub-arachnoid space. Chronic pulmonary tuberculosis is rarely encountered before puberty. No certain explanation exists for the remarkable freedom children between the ages of five and puberty enjoy from tuberculous morbidity and mortality. Possible factors having a bearing upon the high infection rate of chronic reinfection tuberculosis, especially in girls, during the teen age are the increased need for minerals and protein and other metabolic changes which occur in adolescence in association with the establishment of menses. The reaction of every child to tuberculin should be known at or before the onset of puberty. Positive reactors should have, at least annual x-ray films of the lungs made in order to recognize at the earliest possible time, the characteristic soft mottled apical shadows of the early infilliate. Diagnostic tuberculin and the x-ray constitute the bulwarks upon which chief dependence is placed for the diagnosis of the various forms of tuberculous disease occuring in childhood. History of exposure, symptoms of illness and physical findings are relatively poor guide posts. Demonstration of tubercle bacilli by gastric lavage is frequently helpful in clinching a previously suspected diagnosis. Studies of the blood, including the hemogram, sedimentation rate and Schilling differential count are of less value in diagnosis than in estimating prognosis and the favorable or unfavorable course of the disease. The immediate prognosis of all primary tuberculous infections is good, with the exception of the comparatively few children in the first five years of life whose primary complexes extend to the development of such acute reinfection forms as meningitis, miliary disease and tuberculous pneumonia. The remote prognosis however, is more uncertain, both from the point of view of the number who will ultimately develop chronic pulmonary tuberculosis and the number who will die from this form of the disease. An environment safe from the risks of tuberculosis infection should be provided every child. In this preventive phase the pediatrician and the physician can accomplish much. Experiments now being carried on with streptomycin may provide a specific form of therapy, but until its efficacy has been proven, rest, diet, healthful living conditions and time are the general measures to be relied upon for bringing about healing in most of the tuberculous lesions of children. Collapse therapy may occasionally be indicated.

Absorption Collapse in Primary Tuberculous Infection in Childhood

Absorption Collapse in Primary Tuberculous Infection in Childhood

Primary Tuberculous Infection in Childhood: Incidence, Morbidity, and Mortality in an Urban Population

Primary Tuberculous Infection in Childhood: Incidence, Morbidity, and Mortality in an Urban Population

The relationship between primary and adult tuberculosis

(1) The great majority of primary tuberculous infections now take place in the same age groups in which we find the largest percentage of destructive pulmonary tuberculosis. (2) The time interval between the primary infection and the destructive pulmonary tuberculosis is in most cases less than five years, very often only one or two years. (3) Primary tuberculosis is not always benign. Radiologically demonstrable breakdown is no rarity. In some cases primary tuberculosis is apparently very malignant. (4) There is no doubt that destructive pulmonary tuberculosis begins in many cases with a new infiltration which must be assumed to have metastatic origin. (5) The infective dose and superinfection have no effect on the prognosis of primary infection. Age, heredity and environment are the leading factors. The most important practical consequences of this view are that demonstration of the primary infection by tuberculin tests is of decisive importance and that the infection must be carefully watched, particularly in the first few years after it has been contracted.

The Present Status of Tuberculosis in Children

primary infection of tuberculosis may occur at any age. Tuberculosis in infants has a relatively high mortality which subsides in childhood only to rise again in puberty. sensitization conferred by a primary infection opens the way for a destructive phase of tuberculosis to develop. value of the immunity conferred by a primary inoculation is not settled. Tuberculosis in its preclinical form is often difficult to diagnose. It is said that, The child is father of the man, so a primary tuberculous infection is the sire of destructive disease. We should not neglect tuberculosis in children.

Woodward High School Survey

The Woodward High School of Cincinnati, Ohio, was selected for this survey because: (1) It served the great majority of people in the lower economic group, especially from an area of the city where the incidence of tuberculosis was highest. (2) Approximately 50 per cent of its students were negroes. The entire program consisted of tuberculin testing with P. P. D., physical examination and x-raying of 501 eleventh grade students, the majority of whom were between 16 and 18 years of age. There were 372 white and 129 negro students. A total of 467 members of the households of these students were also studied. Five cases of active pulmonary tuberculosis (1.0%); 23 cases of active primary tuberculous infection (4.59%); and, 5 cases of healed pulmonary tuberculosis (1.0%) were found among the students. Two cases of active pulmonary tuberculosis (0.43%); 6 cases of active primary tuberculous infection (1.28%); and, 25 cases of healed pulmonary tuberculosis (5.33%) were found among the household members.

EXPOSURE OF TUBERCULIN-SENSITIVE CHILDREN TO EXOGENOUS INFECTION WITH HUMAN TUBERCLE BACILLI

The role of allergy in the pathogenesis of tuberculosis remains a controversial subject. Extensive studies on this problem have led to the separation of workers in the field into two definite schools. One group is composed of those who, following the teachings of Pirquet, maintain that a person who has passed through a primary tuberculous infection, as evidenced by roentgenograms and positive reactions to cutaneous tuberculin tests, is better able to withstand future exogenous infections.¹ Wallgren^1awrote: There is no doubt that those children who have successfully passed through a primary tuberculosis are to be regarded as a picked group, who, when exposed to a tuberculous infection, are in a more favorable position than uninfected children. It is generally found that children who are tuberculin-positive do not run any risk, if they are exposed to tuberculous infection. The opposing school contends that the primary tuberculous infection, regardless of

TUBERCULOSIS AMONG STUDENTS AND GRADUATES OF MEDICINE

Excerpt The problem of tuberculosis among students and graduates of medicine has been present since the earliest days of medical practice. Valsalva, the anatomist (1666-1723), avoided postmortem ex...

TUBERCULOSIS IN MEDICAL AND NURSING HOSPITAL PERSONNEL

Article1 June 1938TUBERCULOSIS IN MEDICAL AND NURSING HOSPITAL PERSONNELJ. ARTHUR MYERS, F.A.C.P., BENEDICT TRACH, HAROLD S. DIEHL, RUTH E. BOYNTONJ. ARTHUR MYERS, F.A.C.P.Search for more papers by this author, BENEDICT TRACHSearch for more papers by this author, HAROLD S. DIEHLSearch for more papers by this author, RUTH E. BOYNTONSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-11-12-2181 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn a previous paper1reports were presented on three private hospital schools of nursing in which the students were observed with reference to tuberculosis. The hospital of School I operated a tuberculosis division where every student nurse at some time before graduation was compelled to spend three months. In the hospitals of Schools II and III there was no special division but occasional tuberculous patients were admitted for both diagnosis and treatment. These observations have been continued and have brought about so much enlightenment among the personnel that some of our hospitals are now taking steps to control the disease...Bibliography1. MYERSDIEHLLEESLEVINE JAHSHDI: The evolution of tuberculosis in students of nursing and medicine, Trans. Nat. Tuberc. Assoc., 1934. Google Scholar2. WALLGREN A: Primary pulmonary tuberculosis in childhood, Am. Jr. Dis. Child., 1935, xlix, 1105. Google Scholar3. SMITH CH: The tuberculosis of childhood, ANN. INT. MED., 1935, viii, 1090. Google Scholar4. DIEHLMYERS HSJA: Tuberculosis in college students, Trans. Nat. Tuberc. Assoc., 1936. Google Scholar5. HARRINGTON FE: Personal communication. Google Scholar6. MYERSDIEHLBOYNTONTRACH JAHSREB: Development of tuberculosis in adult life, Arch. Int. Med., 1937, lix, 1. CrossrefGoogle Scholar7. 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KUTSCHERA-AICHBERGEN A: Die Behandlung der Tuberkulose mit lebenden Tuberkelbazillen, Wien. klin. Wchnschr., 1929, xlii, 197. Google Scholar16. FRIEDMANN FF: Grunde für hin und wider beobachtetes schienbares Ausbleiben von Heilerfolgen des Friedmannschen Mittels, Deutsche med. Wchnschr., 1921, xlvii, 533. CrossrefGoogle Scholar17. FRIEDMANN FF: Zehn Jahre Friedmann Tuberkulose-Heilmittel, Klin. Wchnschr., 1931, x, 407. CrossrefGoogle Scholar18. FOWLER WC: A preliminary report on the treatment of tuberculosis with turtle vaccine, Tubercle, 1930, xii, 12. CrossrefGoogle Scholar19. FOWLER WC: A further note on the treatment of tuberculosis with turtle vaccine, Tubercle, 1932, xiii, 1. CrossrefGoogle Scholar20. CALMETTEPLOTZ AH: Protective inoculation against tuberculosis with BCG, Am. Rev. Tuberc., 1929, xix, 567. Google Scholar21. Bull. et Mem. Soc. Med. des Hop. de Paris, April 13, 1936, p. 579. Google Scholar22. Editorial, The British Medical Journal, June 20, 1936, p. 1263. MedlineGoogle Scholar23. BURRELL LS: Recent advances in pulmonary tuberculosis, P. Blakiston's Son & Co. Inc., Philadelphia, 1937, p. 27. Google Scholar24. BERNARDDEBRÉ LR: La prophylaxie de la tuberculose chez le nourrisson par le placement familial, Bull. de l'acad. de Med., 1920, lxxxix, 523. Google Scholar25. MYERS JA: Are nurses and physicians protected against tuberculosis? The Trained Nurse and Hospital Review, 1933, lxli, 416. Google Scholar26. MYERS JA: How shall we protect our students from tuberculosis? The Trained Nurse and Hospital Review, 1934, lxlii, 332. Google Scholar27. MYERS JA: The care of tuberculosis, 1924, W. B. Saunders Co., Philadelphia. CrossrefGoogle Scholar28. MCNETT EH: The nursing care of tuberculosis patients, Trans. Nat. Tuberc. Assoc., 1937. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Minneapolis, Minnesota*Presented in part before the joint meeting of the Philadelphia Medical Society and the Pennsylvania Tuberculosis Association, January 20; the Colorado Tuberculosis Association and the Denver Sanatorium Association, Denver, February 22; the Academy of Medicine, Toledo, Ohio, May 21; the 32nd annual meeting of the American Sanatorium Association, Milwaukee, Wisconsin, May 31; and the joint meeting of the Medical Society of the County of Queens and the Queensboro Tuberculosis and Health Association, Jamaica, New York, September 22, 1937.Prepared with the aid of a grant from the Medical Research Fund, University of Minnesota.From the Departments of Preventive Medicine and Internal Medicine, University of Minnesota, and the Lymanhurst Health Center, Minneapolis, Minn. 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TUBERCULOSIS OF THE UPPER PART OF THE RESPIRATORY TRACT: LITERATURE OF THE PAST TWO YEARS

Recently the old debate regarding the possibility of a primary tuberculous infection of the larynx and the associated theories concerning the method of laryngeal invasion seems to have been reawakened. Brieger and Pagel 1 report their findings in 4 cases in which the lesions at first looked very much like primary lesions of the larynx, perhaps of hernatogenous origin. However, in 3 of the cases a careful clinical study showed demonstrable pulmonary lesions. In the other case it was only by careful postmortem examination that the pulmonary lesion was found. Histologic study of part of the pulmonary tissue finally revealed evidence of rupture of a small pulmonary nodule into a bronchus. As far as the pathogenesis of the laryngeal lesion is concerned, Brieger and Pagel say in conclusion: We do not contest the possibility of an independent hematogenous development of a laryngeal lesion, but this should not be overrated. Ruedi, 2 however,

PRIMARY TUBERCULOSIS, OBSTRUCTIVE PULMONARY EMPHYSEMA AND ASTHMA WITH RECOVERY

The occurrence in infancy of tuberculosis, obstructive pulmonary emphysema or asthma, singly, is relatively common. But a primary tuberculous infection causing obstructive pulmonary emphysema and asthma, with recovery, in an infant 9 months old is rare. In fact, a search of the literature failed to disclose a report of such a sequence of events. It was therefore considered advisable to record the following case. <h3>REPORT OF CASE</h3> <i>History</i>.—E. S., a white boy, was born at term on Nov. 7, 1927. Two other children in the family were living and well. He was nursed for two months and then placed on a diet of diluted pasteurized grade A cow's milk, supplemented with orange juice and cod liver oil. He vomited continuously until given whole lactic acid milk. Progress was satisfactory until February 1928, when he caught cold while the house was being painted. He acquired a mild cough, which continued

Tuberculosis of the cervix uteri

Tubereulosis of the cervix is very uncommon. Most cases are secondary infections, which are derived from primary foci elsewhere in the body. The literature on this subject has been partially reviewed. There are probably 300 cases which have been reported in the literature; of these, not more than 35 are primary tuberculous infections of the cervix. Biopsy is the only accurate method of diagnosing this lesion and of distinguishing it from cervical inflammations and carcinomas. Proper treatment appears usually to demand radical surgical procedures so as to insure the highest percentage of permanent cures. The only proved case of this disease which we have been able to find in our records is briefly reported.

EFFECT OF VACCINATION WITH BCG ON TUBERCULOSIS IN INFANCY AND IN CHILDHOOD

It has long been known that a primary tuberculous infection produces a resistance which modifies the course of a subsequent infection with the tubercle bacillus. Numerous attempts have been made to produce immunization against tuberculosis with products of tubercle bacilli and with tubercle bacilli killed by heat, light or chemicals or attenuated by drying, prolonged cultivation on artificial culture mediums or aging the culture. Attempts have also been made to immunize against the disease by means of acid-fast saprophytes and by means of tubercle bacilli which are nonpathogenic for the particular species. These efforts have never been wholly successful. In 1906, Calmette and Guérin¹claimed that resistance to tuberculosis could be induced by impregnating the lymphatic system with living, attenuated tubercle bacilli, which localize there and are incapable of producing generalized tuberculosis. Calmette and Guérin²believed that they had succeeded in modifying a strain of the bovine tubercle

ETIOLOGY OF THE PULMONARY FIBROSES AND MEDICO-LEGAL ASPECTS OF PNEUMONOKONIOSIS

Article1 September 1935ETIOLOGY OF THE PULMONARY FIBROSES AND MEDICO-LEGAL ASPECTS OF PNEUMONOKONIOSISWM. S. MCCANN, M.D., F.A.C.P.WM. S. MCCANN, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-9-3-234 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe medico-legal questions which have arisen in connection with the pneumonokonioses are of two kinds: those which come from common law suits for negligence, and those which are connected with workmen's compensation laws. Many of our states have not yet included pneumonokoniosis in their compensation schedules. In these states a furious battle is being fought in the courts, into which medical men are being drawn by both sides. The physician who is suddenly projected into the "no man's land," which is the territory of the expert medical witness, finds himself between two fires. He is faced with ethical problems of...Bibliography1. BALEFRAY WFW: A method for the analysis of dust samples employing x-ray diffraction, Jr. Indust. Hyg., 1935, xvii, 1. Google Scholar2. BOWMANBIANCO PGAJ: Tularemic pneumonia, ANN. INT. MED., 1934, vii, 1491. Google Scholar3. COLLISYULE ELGU: Mortality experience of occupational group exposed to silica dust, compared with that of general population and occupational group exposed to dust not containing silica, Jr. Indust. Hyg., 1933, xv, 395-417. Google Scholar4. FRASERIRVINE DSLG: Statistical account of the incidence and progression of silicosis among the gold miners of the Witwaters Rand, Silicosis, International Labor Office, Geneva, 1930, p. 618. Google Scholar5. GARDNERCUMMINGS LUDE: Reaction to fine and medium sized quartz and aluminum oxide particles; silicotic cirrhosis of liver, Am. Jr. Path., 1933, ix, 751-764. Google Scholar6. GARDNERCUMMINGSDOWD LUDEGR: Experimental inhalation of bituminous coal dust and its effects upon primary tuberculous infection in guinea pigs, Jr. Indust. Hyg., 1933, xv, 456-465. Google Scholar7. HURTADOKALTREIDERFRAYBROOKSMCCANN ANLWWWDWS: Studies of the total pulmonary capacity and its subdivisions. VIII. Observations on cases of pulmonary fibrosis, Jr. Clin. Invest., 1935, xiv, 81. CrossrefGoogle Scholar8. HURTADOKALTREIDERMCCANN ANLWS: Studies of total pulmonary capacity and its subdivisions. IX. Relationship of oxygen saturation and carbon dioxide content of arterial blood, Jr. Clin. Invest., 1935, xiv, 94-105. CrossrefGoogle Scholar9. IRWIN DA: Microincineration as an aid in diagnosis of silicosis, Canad. Med. Assoc. Jr., 1934, xxxi, 140-143. Google Scholar10. IRWIN DA: Histological demonstration of siliceous material by microincineration, Canad. Med. Assoc. Jr., 1934, xxxi, 135-140. Google Scholar11. KLOTZ O: The pathology of pneumonokoniosis: a review, Am. Jr. Med. Sci., 1934, clxxxviii, 418. Google Scholar12. LANZAVANE AJRJ: Prevalence of silicosis in the general population and its effects upon the incidence of tuberculosis, Am. Rev. Tuberc., 1934, xxix, 8-16. Google Scholar13. MCCANNHURTADOKALTREIDERFRAY WSANWW: Estimation of functional disability in pulmonary fibroses, Jr. Am. Med. Assoc., 1934, ciii, 810-815. CrossrefGoogle Scholar14. MCCONNELLFEHNEL WJJW: Health hazards in foundry industry, Jr. Indust. Hyg., 1934, xvi, 227-251. Google Scholar15. MCNALLY WD: Silicon dioxide content of lungs in health and disease, Jr. Am. Med. Assoc., 1933, ci, 584-587. CrossrefGoogle Scholar16. PANCOASTPENDERGRASS HKEP: Roentgenologic aspect of pneumonokoniosis and its differential diagnosis, Jr. Am. Med. Assoc., 1933, ci, 587-591. CrossrefGoogle Scholar17. PROSKESAYERS HORR: Pulmonary infection in pneumonokoniosis; bacteriologic and experimental study, Public Health Rep., 1934, xlix, 839-858. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Rochester, New York*Read at the Philadelphia meeting of the American College of Physicians, April 30, 1935.From the Department of Medicine, University of Rochester, School of Medicine and Dentistry, and the Medical Clinic of the Strong Memorial and Rochester Municipal Hospitals. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1935Volume 9, Issue 3Page: 234-244KeywordsDentistryEtiologyHospital medicinePneumoniaPulmonary fibrosis ePublished: 1 December 2008 Issue Published: 1 September 1935 PDF downloadLoading ...

HEMATOGENOUS TUBERCULOSIS IN CHILDREN

Knowledge of the pathogenesis of primary tuberculous infection in childhood has been increasing by leaps and bounds in the last fifteen years. And with this has come a revolution in the conception of the part that the blood stream plays in the postprimary development of tuberculosis. Originally dissemination by the blood stream was conceived of as an occasional, much dreaded, invariably fatal accident, the main pathologic feature of which consisted of tubercles of miliary size scattered throughout the body or rarely localized to the meninges or lungs. With the newer knowledge that in probably all cases of primary tuberculosis a few bacilli at least find their way into the blood, there is introduced a different conception of the part that the blood stream plays, and on the basis of clinical and pathologic observations many facts can be interpreted which heretofore have seemed obscure. The conception of tuberculosis as a systemic

Effect of Testicle Extract on Primary Tuberculous Infection and Reinfection in Guinea Pigs

1. Effect on Primary Infection. Testicle extract greatly increased the extent of the local lesions resulting from the intradermal or subcutaneous injection of virulent human tubercle bacilli into guinea pigs. When compared with lesions resulting from the injection of an equal number of tubercle bacilli suspended in salt solution, the increase was estimated at from 10 to 15 fold. The testicle extract was prepared by mincing bull testicle in 2 volumes of physiological salt solution, straining the material through cloth and finally filtering through a Berkefeld V candle. Kept at ice-box temperature, the extract maintains its activity for a long period of time. Two groups of 6 guinea pigs were used in the first experiment, in which the injection was made intradermally. One group was injected with a mixture of 1.0 cc. of testicle extract and 1.0 cc. of a suspension of H-37 strain of human tubercle bacilli in salt solution, containing 0.1 mg. of organisms, moist weight. The other group of 6 guinea pigs was inje...

Tuberculous infection and tuberculosis as modified by experimental pneumonokoniosis

Tuberculous infection and tuberculosis as modified by experimental pneumonokoniosis

The Occurrence of Primary Tuberculous Infection of the Intestinal Tract in Children: The Results of 5,142 Consecutive Necropsies

The Occurrence of Primary Tuberculous Infection of the Intestinal Tract in Children: The Results of 5,142 Consecutive Necropsies