Chest
Volume 57, Issue 6, June 1970, Pages 530-534
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The Loss of Tuberculin Sensitivity in Certain Patients with Active Pulmonary Tuberculosis

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Through a careful determination of the tuberculin sensitivity of patients over a long period of time, a few tuberculous patients have been identified who were no longer able to react to tuberculin. Distinctive clinical and roentgenographic changes and, in some instances, the histopathologic changes associated with this deterioration in sensitivity status are detailed.

Section snippets

Material and Methods

Dilutions made from a 2 liter batch of Old Tuberculin obtained in 1939† have been used during the past 30 years for all routine tuberculin tests at Maybury Sanatorium. Available data4 indicate that the potency of the tuberculin has remained constant. Newly admitted patients at Maybury were given a Mantoux test using 0.1 ml of dilutions of 1:10,000, 1:1,000, 1:100 and 1:10 O.T. serially at 48-hour intervals until

Results

In tabulating the results each patient was assigned to one of five different sensitivity levels, or groups, depending upon the dilution of tuberculin to which he reacted. The final “O” group was reserved for those who failed to react to 1:10 O.T. The proportion of patients found in the various sensitivity groups has been published elsewhere ‡ .4 In the present series bacteriologic evidence of tuberculous infection was found in 55 of

Characteristic Findings in Tuberculin-Nonreactive Patients

Aside from the primary characteristic of failing to react to 10 mg of OT, the nonreactive tuberculous patients have the following findings in common:

  • 1.

    Smears of the sputum show great numbers of acid-fast bacilli* which, on culture, are found to be M. tuberculosis.

  • 2.

    The chest roentgenogram shows cavitation and gives evidence of

Discussion

The term tuberculin-nonreactive is a broad characterization which applies equally to the individual who fails to react to tuberculin because he has never been exposed to the tubercle bacillus, and to the 12 patients listed in Tables 1 and 2. In this respect tuberculin anergy is a more specific term since it implies abnormal hyposensitivity to tuberculin. The 1 mg dose of OT (0.1 ml of the 1:100 dilution) is comparable in potency to the second strength dose (0.005 mg) of PPD9; the patients in

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