Delay in diagnosis of pulmonary tuberculosis resulted in the death of 2 patients from the disease, a fatal outcome for a further patient whose cause of death was not determined, and led to extensive lung destruction in 2 others. A plea is made for early investigation of patients presenting with symptoms suggestive of pulmonary tuberculosis

Collins, T. F. B.

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21 Desember 1974 S.-A. MEDIESE TYDSKRIFAwareness of TuberculosisT. F. B. COLLINS2579SUMMARYDelay in diagnosis of pulmonary tuberculosis resultedin the death of 2 patients from the disease, a fatal out-come for a further patient whose cause of death wasnot determined, and led to extensive lung destruction in2 others. A plea is made for early investigation ofpatients presenting with symptoms suggestive of pul-monary tuberculosis.S. Afr. Med. l., 48, 2579 (1974).Fig. 1. Case 1, an adult female with gross bilateralcavitary pulmonary tuberculosis.Department of Health, PretoriaT. F. B. COLLI IS, M.B. B.CH., D.P.H.Date received: 2 October 1974.In a recent publication' the attention of medicalpractitioners in the UK was drawn to the necessity fora continuing awareness of tuberculosis as a cause oflong-standing respiratory symptoms. The authors des-cribed a family outbreak of tuberculosis in which 5young children were infected by the father who hadchronic bilateral cavitary pulmonary tuberculosis, diag-nosed 4 months previously as bronchitis. Tuberculousmeningitis presented simultaneously in 2 of the children,with a fatal outcome in 1 of them. The danger oftreating adults for persistent bronchitis without investi-gation was emphasised.Pulmonary tuberculosis is a disease of considerablvhigher prevalence in the Republic of South Africa tha~is the case in Britain, and it should not be necessary toFig. 2. Case 2, an adult male with extensive bilateralcavitary pulmonary tuberculosis.2580 S.A. MEDICAL JOUR 'AL 21 December 1974Fig. 3. Case 3, an adult male with gross bilateral cavitarypulmonary tuberculosis.remind our colleagues, particularly those practising amongthe non-White sectors of the population, that tuberculosisshould be suspected when patients present with chroniccough, weight loss, and other evidence of the disease.However, it unfortunately does frequently happen thatpatients are admitted to hospital in an advanced stage ofthe disease after long periods of treatment with variousantibiotics and cough mixtures. The following tragic casehistories are cited in the hope that early diagnosis ofpulmonary tuberculosis will be the result in the future.All were selected as extreme examples from among manyothers in the course of a single visit to a chest hospital.CASE REPORTSCaseIAn adult female was admitted to hospital in anemaciated condition with gross bilateral cavitary pulmo-nary tuberculosis (Fig. I). For 3 months before admissionshe had been treated on numerous occasions by ageneral practitioner with injections and various mixtures,and had also received short courses of tablets. Herprognosis is poor, for although modern specific chemo-therapy can be expected to arrest and heal the tuberculousdisease, she will be left with a destroyed, fibrotic rightlung, which is likely to be the site of recurrent or chronicsepsis.Case 2An adult male had been ill for 2 years with chroniccough, pain in the chest, and weight loss. During thattime he had been treated on numerous occasions forinfluenza, bronchitis and pneumonia, but had never beenreferred for a chest X-ray examination. The cost of histreatment had exhausted his savings, and finally heattended the outpatient department of a general hospital,where extensive bilateral cavitary pulmonary tuberculosiswith right-sided effusion was diagnosed (Fig. 2). He wastransferred to a chest hospital and died the following day.Fig. 4. Case 4, an adult male with a large thick-walledcavity in the right upper lobe and hilateral tuberculousinfiltration.21 Desember 1974 S.-A. MEDIESE TYDSKRIF 2581Case 3An adult male was treated for 'a long time' by generalpractitioners for persistent chest symptoms, and wasultimately admitted to hospital after a haemoptysis, withgross bilateral cavitary pulmonary tuberculosis (Fig. 3).He died 5 weeks later, after a second massive haemoptysis.Case 4This patient, an adult male, was relatively fortunate,for after 4 months of treatment for non-specific chestinfection, he was referred for a chest X-ray examination.By this time, however, he had a large thick-walled cavityin the right upper lobe and bilateral tuberculous infiltra-tion (Fig. 4). Much of the lung destruction might havebeen avoided had he been sent for examination sooner.Case 5An adult female was admitted to a chest hospital inpoor condition, weighing only 22,5 kg, with a moderatelyadvanced pulmonary tuberculous lesion and a painfulswelling of the jaw, which made feeding extremelydifficult. Her employer, a farmer, stated that she hadbeen ill for 3 years, and he had personally taken her toa general practitioner on numerous occasions. She had paidR2,50 per visit, and had ultimately sold some of herfurniture to meet her continuing medical expenses. Whenshe could no longer afford private medical attention, shewent to a provincial hospital, where a chest X-rayexamination was done for the first time. She was admittedto a small chest hospital and subsequently transferredto a larger institution for investigation and managementof the jaw condition, but died soon afterwards. The causeof death was not determined.DISCUSSIONIt must be emphasised that the patients described hereare not exceptional cases, as any medical officer at achest clinic or hospital will testify. An earnest plea istherefore made that any patient presenting with symptomssuggestive of pulmonary tuberculosis be referred withoutdelay for a chest X-ray examination. Such examinationsare performed free of charge at local authority clinics,chest hospitals and by arrangement at most generalhospitals. If there is uncertainty concerning the nearestavailable service, the local authority health department,district surgeon, or regional director of State HealthServices should be consulted. Any difficulties which cannotbe otherwise resolved should be referred to the Secretarvfor Health, Private Bag X88, Pretoria, 0001. -REFERENCEI. Corner, B. D. and Anderson, J. D. (1974): Tubercle, SS, 99.

Awareness of Tuberculosis

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Awareness of Tuberculosis

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