What is a Case of Tuberculosis? The Tuberculosis Case Spectrum in Eight Countries Evaluated from 1235 Case Histories and Roentgenograms

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Abstract
Case histories and chest roentgenograms of patients who comprised representative samples of all cases diagnosed in eight different areas in Europe, Asia and America were submitted for central review and analysis. The case spectrum differed considerably among the centers. The average extent of disease varied between 0.9 and 2.1 quarters of a lung field; the frequency of cavitation between 27 and 50 per cent; and the average diameter of the cavities between 1 and 3 cm. In some centers, the cases were predominantly of a fibrotic-productive nature, while they were mostly exudative in others. Finally, the frequency of bacillary cases varied between 49 per cent and 85 per cent. Even within patients of the same category, for example in respect to nature or extent of disease, great variability was observed. Patients with similar bacteriologic status were not homogeneous with respect to radiologic characteristics as judged by either average extent of disease of frequency of cavitation. The case spectrum of tuberculosis differs greatly in various places. This finding is significant for international comparisons of tuberculosis statistics. The use of an appropriate radiologic classification in addition to the widely recommended bacteriologic definition of a case may be useful for estimation of long-range prognsis and may provide important leads for epidemiologic studies.

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