The Diet, Physical Activity and Accommodation of Patients with Quiescent Pulmonary Tuberculosis in a Poor South Indian Community

A previous report from the Tuberculosis Chemotherapy Centre, Madras, has shown that, if standard chemotherapy is given for one year, the response of patients treated at home in very poor environmental circumstances is nearly as good as that of those treated in sanatorium under much more favourable conditions. This paper reports on a four-year follow-up of all the patients whose disease was bacteriologically quiescent at the end of the year’s treatment. During this period, all the patients were managed on a domiciliary basis : about a quarter of them received chemotherapy with isoniazid alone for two years, another quarter received the drug for one year and the rest received no specific chemotherapy. Despite adverse environmental factors (poor diet ; long hours of work often involving strenuous physical activity ; overcrowded living conditions ; and, for the sanatorium patients, the stresses of returning suddenly to the unfavourable home environment), the great majority of patients in both series maintained quiescent disease throughout the follow-up period. Furthermore, the few patients whose disease relapsed bacteriologically were at no special dietary disadvantage in comparison with those who maintained quiescent disease throughout, nor did they show any appreciable differences in occupation, physical activity or living accommodation. These findings, together with the earlier ones, indicate that, despite adverse environmental circumstances, standard chemotherapy for an adequate period of time is sufficient in the great majority of patients for the attainment of bacteriological quiescence and its maintenance thereafter

The Role of Diet in the Treatment of Pulmonary Tuberculosis: An Evaluation in a Controlled Chemotherapy Study in Home and Sanatorium Patients in South India

Before the advent of antituberculosis chemotherapy, a diet rich in calories, proteins, fats, minerals and vitamins was generally considered to be an important, if not essential, factor in the treatment of tuberculosis. The introduction of specific antituberculosis drugs, however, has so radically altered the management of the disease that the role of diet has to be reconsidered in the light of the recent advances in treatment. An evaluation of the influence of diet in the treatment of pulmonary tuberculosis with isoniazid plus p-aminosalicylic acid was recently undertaken by the Tuberculosis Chemotherapy Centre, Madras, in the course of a controlled comparison of home and sanatorium chemotherapy for tuberculous patients from a poverty-stricken community in Madras City. Despite the fact that during the year of treatment the home patients subsisted on a markedly poorer diet, were physically more active and, on the average, gained less weight than the sanatorium patients, the overall response to treatment in the home series closely approached that in the sanatorium series, although there was a tendency for tubercle bacilli to disappear earlier in the latter. Direct evidence has been presented that none of the dietary factors studied (calories, carbohydrates, total and animal proteins, fats, minerals and vitamins) appears to influence the attainment of quiescent disease among tuberculous patients treated for one year with an effective combination of antimicrobial drugs, and that initial chemotherapy of patients at home can be successful even if the dietary intake is low throughout the period of treatment