Pulmonary function and immunologic abnormalities in miliary tuberculosis

Abstract

In a group of 33 patients with miliary tuberculosis (MTB), pulmonary function testing and bronchoalveolar lavage (BAL) were each performed in 31. The arterial blood gas analysis was done in 13 patients. Mild restrictive ventilatory defect, hypoxemia, and hypocapnia were observed. BAL revealed lymphocytic alveolitis. The lymphocyte subsets were measured in the BAL fluid and peripheral blood in 10 patients. The helper lymphocytes were decreased in the peripheral blood and increased in the BAL fluid. The immunoglobulins (IgG, IgA, and IgM) were significantly increased in the peripheral blood and BAL fluid in 18 patients. Serum complement (C3) (n = 23) and BAL fluid fibronectin (n = 22) were also significantly increased. Lymphocytic alveolitis and the raised levels of IgG and IgA in the peripheral blood and BAL fluid persisted at the end of 9 months of standard chemotherapy for tuberculosis. Long-term studies with larger numbers of patients are required to monitor the course of alveolitis in MTB. An addition of corticosteroids to the antituberculosis drug regimen may be considered in the treatment of these patients.