Why Drugs Are not Enough in the Treatment of Tuberculosis

Abstract

whose cultures had converted on streptomycin and PAS were resected, it was difficult to grow tubercle bacilli from the resected specimens. However, acid-fast rods were present in a large number of these specimens, so the question arose : Are these tubercle bacilli dead or merely dormant?11 By six months after chemotherapy was stopped a significant percentage of the negative nonresected patients with open cavities had reactivated.12 On June 1, 1952, we began our present treatment regimen, consisting of streptomycin, aminosalicylic acid, and isoniazid used concurrently and continuously from admission to discharge, with early resectional surgery when indicated.1 When digested portions of our first 22 resected specimens after June 1, 1952, were cultured, only one patient had a negative gastric culture before resection and a posi¬ tive culture from a digested portion of the specimen. The cultures of the other 21 specimens corresponded to the gastric cul¬ ture before resection. This is an evaluation of results of gastric culture before resection, culture of resected specimens compared with the pathology of the specimens from pa¬ tients who were operated on either during their first hospital admission or after reac¬ tivation. Material and MethodsThe results of the gastric culture before resec¬ tion and the culture of a portion of the specimen using caseous and/or cavitary disease are available for analysis in 171 cases (Table 1). Table 1.-Results of Culture 26 positive before surgery_23 positive specimens 3 negative specimens 145 negative before surgery.--18 positive cultures of specimens 16 positive smear but negative culture 111 negative culture of specimenThe tissue is digested for 24 hours in 2% NaOH solution at 37 C then centrifuged at 3300 rpm for 20 minutes ; the supernatant fluid is poured off and a part of the sediment is stained by Ziehl-Neelsen's method and is examined by microscopy.The remainder of the sediment is neutralized with HCL and cultured on one tube each of modified Petragnani's and Jansen's modification of Lowenstein's media, then incubated for six weeks, and if no growth is visible at that time it is called negative and is discarded.An analysis was made of the results of bronchoscopy and pathology of 168 patients, omitting the 3 patients with positive cultures before surgery and negative specimens-this group is too small to be analyzed. Bronchoscopy is necessary because most bronchial stenosis occurs at the point of resection and thus will not appear in the pathology report. In Table 2, the bronchoscopy findings are broken down into stenosis and bronchitis, the path¬ ology into cavitary, caseous, bronchitis, and bronchiectasis. In order to compare the different groups, the diagnoses are broken down into the percentage of the group having this diagnosis, and each diagnosis is listed separately, although usually more than one condition was present in each patient ; for example, cavitary and caseous disease. These groups include 23 patients with positive cul¬ ture before resection and positive cultu...