Why Do Tuberculous Patients Reactivate?

Reactivation of tuberculosis is due to the presence of virulent viable tubercle bacilli that remain in the tissue. Because of the tendency of the blood vessels in the involved area to be obliterated, chemotherapy does not penetrate into the caseous areas and thick cavitary walls to sterilize these lesions. The other tendency of tuberculosis to obstruct the bronchi with tracheobronchitis prohibits the debris containing tubercle bacilli from being evacuated; therefore this is also a big factor in the reactivation. The extent of disease is a factor because the more extensive the disease, the greater the probability that these serious types of pathology are present. Since the type of pathology present is the main factor in reactivation, our results are as expected. Minimal tuberculosis responds well to drugs only, with no reactivations. In moderately and far advanced disease those patients with resection of these serious types of pathology have fewer reactivations than those who received drugs only. With anteroposterior tomographs and bronchoscopy, using right-angle and fore-oblique telescopes, most of these serious types of pathology can be detected, and it is the physician's responsibility to rule out or remove this pathology before the patient is discharged. Patients have positive gastric cultures for a year or more before they admit having sputum or have x-ray film evidence of new disease, so gastric cultures are necessary to pick up early reactivation. The old ideas that physical exertion, pregnancy, etc., are the causes of reactivation are not true.