Significance of the tuberculin skin test in pulmonary tuberculosis in Jamaica: comparisons of culture-positive, culture-negative and non-tuberculous patients

The results of tuberculin skin tests with PPD-S done on patients with pulmonary tuberculosis seen over a three-year period (1979-1981) were compared with the results of similar tests done during the same period in a group of persons without tuberculosis. Ninety per cent of patients with culture-positive tuberculosis had positive tuberculin skin tests, compared to 83 percent of positive tests in the non-tuberculous group. The presence of such a large proportion of positive tuberculin reactions in persons without active disease indicates that the skin test reaction cannot be used on its own to establish the diagnosis of tuberculosis in Jamaican adults. Eighty of 239 persons with a clinical diagnosis of pulmonary tuberculosis had negative sputum smears and cultures for acid-fast bacilli. Eighty-two percent of these patients had positive tuberculin skin tests. Invasive diagnostic tests and newer serological diagnostic methods are likely to increase the yield of confirmed positive cases of tuberculosis in the future (AU)

Intradural extramedullary tuberculoma

A case of intradural, extramedullary tuberculoma presenting 5 years after the initial infection is described. The rarity of this discrete form of the disease is indicated and the excellent result which can result from a combination of surgery and chemotherapy is emphasized (AU)

The efficacy of short course chemotherapy for tuberculosis in Jamaica - abstract

The use of rifampicin has reduced the duration of therapy in tuberculosis considerably. Short course chemotherapy aims at reducing the dutation of therapy while maintaining optimum efficacy. The regime used in this study was: Isoniazid (H) 300 mg, Rifampicin (R) 450-600 mg and Pyrazinamide (Z) 800-1200 mg as a single oral dose daily with Streptomycin (S) 1 gm intramuscularly daily for two months as hospitalized therapy, followed by Isoniazid 300 mg and Thiacetazone (T) 150 mg daily for six months after discharge. Between 1979 and 1981, 38 cases with AFB positivity were treated with 2SHRZ/6HT. There were 15 males and 23 females with a mean age of 31 years. In 37 patients, cough was the predominant symptom, with expectoration in 14. Loss of weight was seen in 21 and fever in 15. In all cases, there was radiological evidence of cavitation in the upper lobes. Therapeutic evaluation showed weight gain and return of appetite within two months. Sputum conversion to culture negatively was seen in 1 to 14 weeks with a mean of 46 days for males and 55 days for females. In 17 cases, there was a transient rise in uric acid level, a side-effect of Pyrazinamide, with no clinical consequence. One case of arthralgia was seen. We recommend the 2SHRZ/6HT regime as the most effective, and the cheapest short duration therapy for tuberculosis in Jamaica (AU)

Pulmonary alveolar proteinosis in Jamaica

The clinical radiological and pathological features of two cases of pulmonary alveolar proteinosis are described. A further three cases have been diagnosed in Jamaica since 1960 and a summary of the clinical, radiological and pathological features of these cases is also presented. (AU)