ABSTRACT
In 1977, a comprehensive tuberculosis management program was introduced at a medical facility which then served approximately 65,000 black gold miners. The effectiveness of this program was evaluated from the relapse rate after treatment in 2,776 men. Post-treatment follow-up averaged 23.5 months. Limited information on potential determinants of relapse was available for all subjects and more detailed information for subsets. The drug regimen was the major determinant of relapse. Age was not a determinant of relapse nor was primary resistance of Mycobacterium tuberculosis to antituberculosis drugs, which was infrequent. The initial extent and severity of disease had a direct relation with the risk of relapse. The risk of relapse was greatest during the first 3 yr after treatment but persisted for the duration of the observation period. Neither continued exposure to mine dust nor the presence of pre-existing silicosis were shown to be determinants of relapse. A 4.5-month, four-drug weekday regimen was identified as being particularly effective in this working population and may be suitable for use in other working populations in the developing world.
Subject(s)
Gold , Mining , Tuberculosis, Pulmonary/drug therapy , Actuarial Analysis , Adult , Antitubercular Agents/therapeutic use , Drug Evaluation , Drug Therapy, Combination , Follow-Up Studies , Humans , Male , Recurrence , Risk Factors , Silicotuberculosis/drug therapy , Silicotuberculosis/epidemiology , South Africa , Tuberculosis, Pulmonary/epidemiologyABSTRACT
A group of patients with new or enlarging apical lung lesions thought to be tuberculous was randomly selected for observation without treatment. All were tuberculin-positive and all had sputum negative for Mycobacterium tuberculosis on direct examination and on culture. Of the 152 patients, 88 (58%) developed bacteriologically confirmed pulmonary tuberculosis during a follow-up period of up to 65 months.
Subject(s)
Sputum/microbiology , Tuberculosis, Pulmonary/diagnosis , Follow-Up Studies , Humans , Male , Mycobacterium tuberculosis/isolation & purification , Tuberculin Test , Tuberculosis, Pulmonary/microbiologyABSTRACT
A group of 250 patients with new or enlarging apical lung lesions which were thought to be tuberculous, and who had positive tuberculin tests but negative sputum smears and cultures for Mycobacterium tuberculosis, were treated with an ultrashort (3-month), 4-drug (rifampicin, isoniazid, pyrazinamide and ethambutol) regimen. One patient developed bacteriologically positive pulmonary tuberculosis (PTB) during the treatment period and 35 others (14%) developed bacteriologically positive PTB after completing the drug regimen.
Subject(s)
Antitubercular Agents/administration & dosage , Tuberculosis, Pulmonary/drug therapy , Antitubercular Agents/therapeutic use , Drug Therapy, Combination , Ethambutol/administration & dosage , Ethambutol/therapeutic use , Follow-Up Studies , Humans , Isoniazid/administration & dosage , Isoniazid/therapeutic use , Male , Pyrazinamide/administration & dosage , Pyrazinamide/therapeutic use , Random Allocation , Rifampin/administration & dosage , Rifampin/therapeutic use , Time FactorsABSTRACT
A group of 150 patients with sputum-positive pulmonary tuberculosis was treated with a regimen containing only orally administered drugs. Rifampicin and pyrazinamide were combined with Isoprodian, which contains isoniazid and also prothionamide and diaphenylsulphone. All the drugs were given daily for 5 months. Early analysis of the results shows 5 treatment failures, 27 relapses of pulmonary tuberculosis and another 17 patients who did not complete the prescribed regimen.
Subject(s)
Antitubercular Agents/administration & dosage , Dapsone/administration & dosage , Isoniazid/administration & dosage , Isonicotinic Acids/administration & dosage , Prothionamide/administration & dosage , Tuberculosis, Pulmonary/drug therapy , Administration, Oral , Antitubercular Agents/therapeutic use , Dapsone/therapeutic use , Drug Combinations/administration & dosage , Drug Combinations/therapeutic use , Drug Therapy, Combination , Humans , Isoniazid/therapeutic use , Male , Patient Compliance , Prothionamide/therapeutic use , Pyrazinamide/administration & dosage , Pyrazinamide/therapeutic use , Rifampin/administration & dosage , Rifampin/therapeutic useABSTRACT
The use of short-course chemotherapy in silicotuberculosis in the goldmining industry in South Africa is described in a comparative trial of 94 cases of silicotuberculosis and two matched-pair control groups with pulmonary tuberculosis only. The theoretical and practical considerations of short-course chemotherapy are discussed. It is concluded that this is an effective means of treatment for pulmonary tuberculosis in patients with silicosis as well as in patients with pulmonary tuberculosis only, irrespective of previous exposure to silica dust. There are no valid reasons why the basic tenets of short-course chemotherapy for the treatment of pulmonary tuberculosis should not apply in silicotuberculosis.
Subject(s)
Antitubercular Agents/administration & dosage , Mining , Silicotuberculosis/drug therapy , Adult , Clinical Trials as Topic , Drug Therapy, Combination , Gold , Humans , Male , Recurrence , Tuberculosis, Pulmonary/drug therapyABSTRACT
We present the results of 750 consecutive pleural biopsies performed with the Abrams pleural biopsy punch to indicate the effectiveness, safety and ease of the procedure. The biopsies were performed by 27 members of our medical staff. Pleural tissue was obtained in 90% of the biopsy specimens taken from patients with pleural effusions and in 79% of those taken in the absence of pleural fluid. These 'dry' biopsies were restricted to those operators with a minimum experience of 50 previous biopsies. Inclusion of tissue other than pleura occurred more frequently in the 'dry' biopsies (16.6%) than in those with pleural fluid (0.8%). There were no complications which required intervention. The problem of 'idiopathic' pleural disease is discussed. We emphasize the biopsy technique and the need for a constant and interested histologist.
