CORTICOSTEROIDS AND TUBERCULOSIS

• Published in: Kekkaku(Tuberculosis) Vol. 49; no. 11; pp. 393 - 398
• Main Authors: HORIE, Kazuo, TAJIMA, Gen, NONAKA, Takuyuki, UZAWA, Takeshi
• Format: Journal Article
• Language: English
• Published: JAPANESE SOCIETY FOR TUBERCULOSIS 1974
• ISSN: 0022-9776; 1884-2410
• DOI: 10.11400/kekkaku1923.49.11_393

A quarter of century has passed since the discovery of cortisone, and various derivatives with higher potency and less side-effects have been found and applied in the wide range of diseases, but the antiinflammatory and immuno-suppressive effects of the drug were not separable. Many papers which have been published so far, reported on one hand, the beneficial effect of steroids used as the adjunct therapy with chemotherapy in tuberculosis, on the other hand, acute exacerbation of latent tuberculosis induced by steroids currently used in various diseases. In this report we have aimed at the reevaluation of steroids in the treatment of tuberculosis. Eleven cases of miliary tuberculosis, five cases of meningeal tuberculosis, of which three were found associated with miliary tuberculosis and two with pulmonary tuberculosis, and 80cases of tuberculous pleurisy admitted into our hospital during the period of fifteen years from 1957 to 1971 were studied. One case of meningeal tuberculosis seems to have been induced by steroids. All cases of miliary and meningeal tuberculosis have survived without sequelae by using steroids as the adjunct therapy. As regards tuberculous pleurisy, a comparative study of 61cases treated by chemotherapy with steroids and 19 cases treated by chemotherapy alone has been made. Statistically no significant difference has been found in the residual pleural adhesion contrary to our expectation. Out of cases treated by chemotherapy with steroids rebound phenomenon occurred in 15 cases and three cases presented reactivation of latent tuberculosis as against none from those treated by chemotherapy alone. In summary, as being a double-edged sword, the place of steroids in the treatment of tuberculosis should be limited. For meningeal tuberculosis the steroids have a definite indication to suppress the fatal blocking of spinal. Canal miliary tuberculosis itself can be cured by chemotherapy alone but steroids should preferably be used to avoid meningeal complication. However it would be useless to administer steroids systematically in the cases of tuberculous pleurisy except its limited use in relieving severe symptoms.