PATHOGENESIS OF A FIRST EPISODE OF CHRONIC PULMONARY TUBERCULOSIS IN MAN - RECRUDESCENCE OF RESIDUALS OF PRIMARY INFECTION OR EXOGENOUS REINFECTION

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Abstract
Data from the literature on the development of tuberculosis in 2 comparable groups of persons were reviewed and analyzed: 1 group exposed heavily to tuberculosis and the other exposed only in the course of living in European cities in the period of 1920 to 1940. Tuberculosis in tuberculin-negative subjects developed proportionate to exposure; among heavily exposed subjects the tuberculin reactors enjoyed a distinct protection from development of disease; among tuberculin reactors the development of chronic tuberculosis did not appear to be influenced by reexposure to the infection. There is evidence that man is as difficult to reinfect as are the various laboratory animals in which the problem was studied. The disadvantage of the protection acquired from a healed virulent infection is the danger of reactivation later in life. Such reactivation may occur in various organs, but is most common in the lungs where hematogenous metastases during the primary infection often leave nodular upper lobe residuals. An unusual case is presented to illustrate the development of chronic pulmonary tuberculosis 17 years after primary infection despite remarkable protection from further exposure. Chronic pulmonary tuberculosis develops from reactivation of dormant foci implanted during primary infection. The need now is to elucidate the mechanism by which late activity develops even after many years of apparent good health and a stable host-parasite relationship.

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