Primary Tuberculosis Acquired in Adulthood

1) Primary tuberculosis develops in nearly all children in communities and nations where large numbers of persons with contagious tuberculosis remain in their homes and tuberculosis is prevalent among domestic animals.

2) The tuberculin reaction alone indicates the presence of primary tuberculous lesions. X-ray inspection of chests of children who have recently become allergic to tuberculoprotein rarely reveals the location of primary lesions in more than 5 to 8 per cent. The remainder are too small or not sufficiently dense, are in the 25 per cent of the lungs not visualized or are extrathoracically located.

3) Primary tuberculous lesions begin to develop in tissues that are not allergic to tuberculoprotein. Therefore the defense reactions are mild and nonspecific. The disease is usually benign. Symptoms, if present, are mild and fleeting. Occasionally lymph nodes and nodules draining primary pulmonary lesions become so enlarged as to extrinsically occlude bronchial ramifications. Again, exudate from the lesion or ulcerative foci in bronchial mucosa cause obstruction and atelectasis results.

4) As primary lesions develop, tissues of the body become sensitive to tuberculoprotein, which thereafter is a deadly poison to them. Therefore, allergic tissues react in an intense and specific manner to invasions of tubercle bacilli. Lesions which develop in such tissues are of the reinfection or clinical type.

5) About the time allergy is established, erythema nodosum, pulmonary infiltrates and enlargement of hilum structures may be found in a small percentage of children. Soon thereafter the occasional child may develop acute reinfection type of tuberculosis such as pneumonia, miliary disease, meningitis, pleuritis, pericarditis and peritonitis. Later, chronic reinfection type of disease may appear extrathoracically, especially in bones and joints. Rarely does chronic reinfection type of pulmonary disease appear inn children. However, among those infected in childhood this form of the disease begins to become manifest during adolescence and increases in frequency as age advances.

6) In this country primary tuberculosis develops more often in adults than in children, inasmuch as the infection attack rate is essentially the same in the two groups and since the period of adulthood is more than three time that of childhood.

7) Primary lesions which develop in adults are usually benign and present the same allergic manifestations in approximately the same proportion as in children. Atelectasis is less frequently seen in adults primarily infected, probably because of the larger size and more rigid walls of the bronchi.

8) Observations have revealed that the theory to the effect that primary tuberculosis in adulthood is a more serious disease than that acquired in childhood is untenable.

9) Since x-ray shadows are not pathognomonic, there is no possibility of differentiating between primary and reinfection type of lesions by the shadows they cast. Lesions which appear about the time tissues become sensitive to tuberculin are practically always primary, while those that appear months or years later represent reinfection type from endogenous or exogenous sources. The time when tissues become sensitive to tuberculoprotein is the determining factor in differential diagnosis.

10) The management of primary tuberculosis acquired by adults is no different than that of the child. All adults with primary tuberculosis, whether acquired in childhood or adulthood, are potential cases of acute and chronic reinfection forms of the disease and should be examined periodically and advised to report promptly if symptoms appear suggestive of meningitis, pneumonia, miliary disease, pleurisy, etc., in the intervals between regular examinations.

11) The only dependable method of preventing adults from acquiring primary tuberculosis consists of barring of tubercle bacilli from their bodies. Introduction of organisms of reduced virulence produces primary lesions. Proper management of cases of tuberculosis and employment of strict contagious disease technic have proved to be efficacious.