Dysregulation of homeostasis of blood T-lymphocyte subpopulations persists in chronic multibacillary pulmonary tuberculosis patients refractory to treatment.

Design: The dysregulation of homeostasis of blood-T lymphocyte subpopulations was studied in 21 cases of chronic, multibacillary pulmonary tuberculosis refractory to treatment. The clinico-bacteriological and immunological parameters studied in these cases (Gr A) were compared with those of a group of 10 newly-diagnosed drug sensitive cases of pulmonary tuberculosis (Gr B) at the beginning of the study and after 3 months of chemotherapy for tuberculosis. The chronic cases were treated with drugs selected from a reserve line. 10 normal healthy individuals were included in this study as a control group.

Results: At the beginning of the study the mean CD4/CD8 lymphocyte ratios in the refractory cases (0.69) and the newly diagnosed cases (0.81) were significantly lower than those of the normal control subjects (1.84). After 3 months of chemotherapy all but 3 of the newly-diagnosed cases showed clinical improvement, and all became sputum-negative. Their CD4/CD8 ratio recorded a rise to near normal (1.54). On the contrary, following 3 months of reserve-line regimen, only 7 of the 21 group A cases showed sputum conversion. In all of the refractory cases, irrespective of sputum conversion, the CD4/CD8 ratio remained low (1.05).

Conclusion: This probably indicates that due to a long-standing bacillary load in drug resistant pulmonary tuberculosis patients the dysregulation of homeostasis of blood-T lymphocytes becomes persistent. This in turn delays their clinical and immunological recovery, even when therapy is adequate.