Problems in Pulmonary Tuberculosis

¹ Consultant, Division of Tuberculosis Control, Health Dept. of Puerto Rico

Diagnostic problems often arise from the failure of the physician to do the tuberculin test for the purpose of differential diagnosis. When properly applied, it is one of the surest and simplest ways of ruling out tuberculosis.

One should avoid too much confidence in the x-ray film of the chest and not enough reliance on bacteriologic examination of the sputum. Periodic sputum cultures are indispensable for ascertaining the success of the treatment.

Cases of active tuberculosis should be seen at least once a month. Periodic evaluations of drug treatment should be done every six months, including drug sensitivity tests and consultations with the thoracic surgeon.

Most therapeutic problems arise from not recognizing the importance of adequate treatment during the first months of illness. It is extremely important that every tuberculous patient be given the very best of treatments during those crucial months after the first symptoms appear.

All the contacts of a tuberculous patient should be given isoniazid for one year. This important protection may fail unless a good system of follow-up is available to make certain that the drug is taken regularly by every member of the family during the time prescribed.

The chronic incurable case of pulmonary tuberculosis constitutes a major challenge to public health authorities and to physicians in general. With adequate attention to every case of pulmonary tuberculosis from the beginning, chronic incurable cases should become rarer every day.