The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...
The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ... The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...
Fig. 3 X-ray chest showing complete atelectasis of left lung with marked mediastinal shift to left complete obstruction. The super added conditions, if promptly controlled, may lead to removal of the obstruction and reversal of the collapse 3 The two cases reported here were fresh cases of tuberculosis. While collapse in tuberculosis, usually lobar or segmental, may occur, an acute Unilateral whole lung collapse in tuberculosis is rather uncommon. Unfortunately, bronchoscopy could not be done in both the cases. In this situation, the management of the two cases was based on treating the tuberculosis granulation tissue in bronchus plus super added acute respiratory infection leading to complete obstruction of bronchial lumen. The left bronchus Fig. 4 X-ray chest after three weeks showing near total expansion of left lung. Both upper zones reveal few tubercular lesions being long, narrow and oblique is perhaps more vulnerable to obstruction. References 1. Seaton, A., Seaton, D. & Gordon Leitchv A. : Crofton and Douglas's Respiratory Diseases. Fourth Edition, Oxford University Press, Delhi, 1989, pp. 396 2. Perry, K.M.A. and Sellers, T.H: Chest Diseases, Vol. 2, Butterworth and Co. London. 1963, pp. 507. 3. Fraser, R.G., Pare, J.A.P., Pare, P.D. Fraser, R.S. and Genereux, G.P: Diagnosis of Diseases of the Chest. 3rd Edition W.B. Saunders, Company, Philadelphia, 1988, pp. 473.
Continuing Medical Education Ind. L Tub., 1992, 39, 53 TUBERCULIN SKIN TEST* A.N. Sashidhara 1 and K. Chaudhuri 2 Introduction The tuberculin skin test has a 100 year old chequered history. Its use and validity were very different at the start compared with what they are today. After the discovery of the tubercle bacillus in 1882, Robert Koch began experimenting with its growth on culture media in the laboratory. By 1890, he had developed a brownish, transparent, broth culture filtrate which he named “tuberculin”. Soon followed his announcement that tuberculin “protected against tuberculosis in guinea pigs, and had a specific healing effect on tuberculosis processes of all kinds in human beings”, which claim proved to be baseless. However, his observation that the “subcutaneous inoculation of tuberculin in a tuberculous patient led to a rise in temperature and local reaction at the inoculation site, whereas it had no such effect on the non-tuberculous” laid the foundation at that time, for its use in the diagnosis of tuberculosis. However, neither a standard tuberculin preparation nor a uniform technique for testing was developed. In 1907, Von Pirquet demonstrated that on skin “a tiny scratch made through a little quantity of tuberculin.... produced evidence of tuberculin sensitivity”, which observation was the next step in the long journey towards the present day tuberculin test. In 1908, Charles Mantoux used a syringe to administer a measured quantity of tuberculin, at a desired depth in the skin (Mantoux test), which has since become the standard procedure for doing the tuberculin skin test. No doubt, several other methods for doing the test have been developed but none can be standardized, qualitatively and quantitatively, as is possible with the Mantoux test. In order that the test could be used, by clinicians to identify persons at a higher risk of developing tuberculosis and epidemiologists to meas- ure the extent of tuberculosis infection in the community, Carrol E. Palmer and his co-workers identified, around 1950, most of the shortcomings of the tuberculin skin test, and developed ways to overcome them. Their monumental researches led to the desired standardization of the test, thus retaining its value as a reference test for other competing tuberculin tests. They showed that a significant reaction (say > 10 mm) merely indicated infection with M. tuberculosis, and the person being at a higher risk of developing the disease. The isolation of tubercle bacillus, from a specimen obtained from a person and/or detection of characteristic tissue changes in a biopsy specimen was essential to establish the definitive diagnosis. In other words, even the currently used standard tuberculin skin test has shortcomings, which are being overcome by a very careful interpretation of the results, making it a very valuable epidemiological tool, but hardly a-diagnostic test. Tuberculins Currently, two main tuberculin preparations are in use: Old Tuberculin (OT) which is a M tuberculosis broth culture, containing soluble portions of the used culture medium and lysis products of one or more strains of the bacillus, filtered and concentrated to a desired volume; and Purified Protein Derivative (PPD) which is a pure mixture of protein polysaccharides derived from the bacillus by a process developed by Seibert et al. The OT is a crude product containing many extraneous agents that produce cross reactions to many mycobacteria of non-tuberculosis type. The composition and quantities of the active principles in different preparations of OT are never * Abridged and condensed from : The Tuberculin Skin Test - Emerging 100 years since its first use\ NTI Newsletter (1990), 26, 1 & 2, Supplement. 1. Investigator; 2. Director, National Tuberculosis Institute, 8, Bellary Road, Bangalore- 560 003.
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Fig. 3 X-ray chest showing complete atelectasis <strong>of</strong> left<br />
lung with marked mediastinal shift to left<br />
complete obstruction. <strong>The</strong> super added<br />
conditions, if promptly controlled, may lead to<br />
removal <strong>of</strong> the obstruction and reversal <strong>of</strong> the<br />
collapse 3<br />
<strong>The</strong> two cases reported here were fresh cases<br />
<strong>of</strong> tuberculosis. While collapse in tuberculosis,<br />
usually lobar or segmental, may occur, an acute<br />
Unilateral whole lung collapse in tuberculosis is<br />
rather uncommon. Unfortunately, bronchoscopy<br />
could not be done in both the cases. In this<br />
situation, the management <strong>of</strong> the two cases was<br />
based on treating the tuberculosis granulation<br />
tissue in bronchus plus super added acute<br />
respiratory infection leading to complete<br />
obstruction <strong>of</strong> bronchial lumen. <strong>The</strong> left bronchus<br />
Fig. 4 X-ray chest after three weeks showing near<br />
total expansion <strong>of</strong> left lung. Both upper zones<br />
reveal few tubercular lesions<br />
being long, narrow and oblique is perhaps more<br />
vulnerable to obstruction.<br />
References<br />
1. Seaton, A., Seaton, D. & Gordon Leitchv A. :<br />
Cr<strong>of</strong>ton and Douglas's Respiratory Diseases.<br />
Fourth Edition, Oxford University Press, Delhi,<br />
1989, pp. 396<br />
2. Perry, K.M.A. and Sellers, T.H: Chest Diseases,<br />
Vol. 2, Butterworth and Co. London. 1963, pp.<br />
507.<br />
3. Fraser, R.G., Pare, J.A.P., Pare, P.D.<br />
Fraser, R.S. and Genereux, G.P: Diagnosis <strong>of</strong><br />
Diseases <strong>of</strong> the Chest. 3rd Edition W.B.<br />
Saunders, Company, Philadelphia, 1988,<br />
pp. 473.
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