The average physician today, regardless of his specialty, has been lulled into a false
sense of security concerning tuberculosis. This has been brought about mainly by the
fall in the tuberculous death rate. However, the average physician fails to appreciate the
fact that the number of new cases each year and the extent of disease present in
patients admitted for treatment are the same as they were at least ten years ago. This
includes all types of tuberculosis-primary, reinfection, pulmonary and extra pulmonary-
and all ago groups. In addition, in recent years. tuberculous like disease caused by
chromogenic acid-fast bacilli has been reported with increased frequency. These atypical
(chromogenic) acid-fast organisms have been associated with a wide variety of clinical
syndromes, which have a disease spectrum similar to that of human tuberculosis,
Certainly the actual clinical course of infections due to photochromogens and other
atypical acid-fast organisms has not been well defined because of the relative paucity of
cases and lack of controlled study. However, I trust that these opening remarks indicate
tile need for continued respect for the genus of microorganisms, mycobacteria, known
for its ,single definitive feature: Acid fastness.
It is treacherous to attempt to speak about such a broad subject as "Tuberculosis".
The evolution of tuberculous pathology, factors in the general management of the
tuberculous patient, etc., are subjects in themselves worthy of lengthy discussion and
debate. The treatment of pulmonary tuberculosis remains a challenge both to the
internist as will as the chest surgeon despite the apparently phenomenal success of
present day medical therapy. Therefore, it would also be unwise for me to attempt here
today to discuss treatment except in its broadest aspects. Thus, I have chosen as a title
for this presentation one which allows me a lot of leeway and as stated random
thoughts.
|