الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
~be aim of ~his work was to study the levels of
the serum proteins serum polysaccharides; their electbophoretic
pattern, and the erythrocyte sedimentation
rate in cases of active pulmonary tuberculosis before
the ini tia tien of antituberculous treatment. AlB 0
the changes produced as a result of, and after the
long term treatment to determine the degree of activi
ty of the tuberculous dis ease.
This work was carried out with the idea that the
study of those changes may help in the follow up of
the degree of activity, prognosis of these cases and
to detect which parameter is more sensitive as an aid
for this follow up.
In addition to the usual clinical assessment of
all cases, rtlentgenorgrapby, sputum examination by
direct smear and culturel a full blood picture including
the erythrocyte sedimentation rate was done. The
total serum proteins was estimated by the biuret method,
while th~ different serum protein fractions were separated
using the paper electrophoretic technique.
The total serum polysaccbarides was determined
by the orcinol sulphuric method, and the different
fractions were also separated by paper electrophoresis
and stained by Ktliw, and Gronwall technique.
All these determinations were done for each case
at the start of treatment, a nd monthly for periods
varying between 12-16 months.
The material oomp~ised 101 cases - 59 males and
42 females. They were subdivided into two groups.
Tho first group included 71 casas - 44 males and
27 females. 7 cases haa pleural effusions and 64 cases
bad active pulmonary tuberculosis. Nearly all cases
have not had received any previous antituberculous
trea1iment.
The second group included 30 normaf, adults - 15
males and 15 females - 10 - 40 years old, as a control
group.
All cases received a standard t~eatment of streptomycin
1 gm / day, Para-amino-salicylic acid 12
Gs / day, and isonicotinic acid hydrazide 300 mgms/day.
Only 6 cases necessitated, the addition of drugs of the
seoond lino in the form of oycloserine or ethionamide.The total serum proteins tended to remain within
the no.rmal range in all oases regardless of the extent
of the disease. There was a tendency for the mean
total serum proteins to fall as the e:ctent of the disease
advancos but was still within the normal range.
Only 6 cases with far advanced cavitory disease showed
hypoprotoinaemic levels. In these 6 cases the level
returned to normal within 3 months of treatment.
Using paper electrophoresis; there was mild
hypoalbuminaemia which was mOre manifGst the larger
the oxtend of pulmonary involvement. It tended to
return to normal within 9 months of treatment regardless
of the activity of the disease. The lo~~st
albumin concentration was noted in cases with coexistent
diabetes mellitus or pregnancy. Gases which
had received preVious anti~berculous treatment had
a decidedly higher albumin concentration.
The alpba-2-globulin showed a decidedly higher
values in all cases of recent active pUlmonary tuberculosis
and pleural effusion. The elevation was in
direct proportion to the extent of the diseaSe. The
highest elevation recorded was in cases of pulmonary
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tuberculosis with coexistent d~etes mellitus or
pregnancy. The alpha-2-g1obulin was lower in oases
which had received previous treatment. The alpha.-2-
globulin tended to return to normal within 6-9 months
of treatment.
No significant changes were detected in the Bglobulins.
Hypcrgammaglobulinaemia was a feature of all
oases of active pulmonary tuberculosis and pleural
effusions. It was noted that the two cases which bad
tuberculous mediasiiinal lymphadenopathy showed the
highest gamma globulins of all cases. Hypergammaglobulinaemia
was the main change noted in minimal oases,
the level of gammaglobulins tended to fall rapidly
,at first as a result of treatment, and then slowly.
It attained a normal level witbin 9 months to one
year regardless of the extent of pUlmonary involvement
or activi~GY~
The albumin / ~ ratio was decidedly reduoed in
all oa.es of active pulmonary tuberculosis and pleural
effusions. There was a definite correlation between
the extent, duration and severity of the lesion and
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the changes in the albumin / a2 ratio. It was exceptionally
low in cases of pulmonary tuberculosis with
associated diabetes mellitus or pregnancy. The
albumin / a2 ratio returned to a normal level within
6 months in minimal cases and those with pleural effusion;
within 9 months in moderately advanced and one
year in far advanced oavitory cases.
The A/G ratio was also reduced in all cases of
active pulmonary tuberculosis and pleural effusions.
The larger the extent of pulmonary involvement; the
lower the ratio. The lowest ratio was recorded in
cases of active pulmonary tuberculosis with coexistent
pregnancy. It; tended to return to normal rapidly as
a result of treatm.ent attaining normal values within
9 months in most of the cases. Both the Alb/a2 and
A/G ratios were lower in cases with cqvita tioD than
those with no dete~table cavities.
The total serum polysaccharid8s. showed decidedly
higher values in all cases of active pulmonary tuberculosis
and those with pleural effusions. The serum
polysaccharide level showed a progressivo rise as the
extent of pulmonary involvement increases, the highest
level in bilateral cases with all zones affected.
No correlation could be detected between the total
serum polysaocharides and the hypersensitivity state
as detected by tuberculin testing. The serum polysacoharide
level was particularly high in cases of
active pulmonary tuberculosis with associated diabetes
mellitus or pregnancy. Cases which had received
previous antitruberculous treatment (i.e. lesser
activity of the disease as a result of treatment )
showed a decidedly lower values than in the group which
had no previous treatment. Cases arrostedby sur@Bry
had a serum polysaccharide level more or less as in
the normal control group.
The total polysaccharide level tended to drop
rapidly at first after the initiation of treatment and
”then gradually. It attained a normal value within 6
months of treatment in cases of pleural effusion, 9
months in minimal cases, one year in all the remaining
groups including trhe far advanced cavitary group with
most lung zones. affected. Only 6 far advanced
cavitory cases with persistent activity 12-15 months
after treatment with positive sputum either by direct
smear or culture showed a high total serum polysaccharides,
Cases of relapse showed an earlier elevation
of the total serum polysaccharides long before sputum
reversion or elevation of E.S.R.
Cases with cavi~ation showed a higher total serum
polysaccharides than those without detectable cavities.
Electrophoretic separation of serum polysaccharides
showed a general tendency for the alpha globulins to
be raised in cases of active pulmonary tuberculosis and
pleuxal effusions. They showed definitely higher values
in cases with coexistent diabetes mellitus or pregnancy.
The alpha globulins tended to return to normal as a
result of treatment.
The mean erythrocyte sedimentation rat’e tended to
show high values in caSes of ple~al effusion. Also
it tended to have a higher level the more the extent
of pulmonary involvement. The highest mean values were
recorded in cases of active pulmonary tuberculosis with
coexistent pregnancy or diabetes mellitus. It tended
to fall rapidly at first in all cases as a result of
~reatment and then gradually. It attained a normal
value within 6 months of treatment in minimal cases and
thoa e with pleural effus ions and in 9 months in all cases except the fax advanced oavitory group where it
needed ont: year.
Cases which had persistent activity after 12 -
15 months of follow up -with positive sputum either
by direct smear or cutl~e) showed a .high total S \-;’l’um
polysaccharides, a mild elevation of E.S.R in some
cases and a normal mean in others i while the total serum
serum proteins and their electrophoretic pattern was
within normal. It is remarkable toot the 3 deaths
recorded were 1’D this group.. So a persistently high
total serum polysaccharides denotes a bad prognosis.
So it is deduced from this ·study tbat:-
(1) The total serum proteins were within the normal
range in most cases of active pulmonary tuberculosis
with occasional hypoproteinaemia in some far
advanced oavitary cases.
(2) The changes in tbe Albumin / a2 ratio and A/G
ratio and total serum polysaccharides ran parralel
with the extent of pulmonary invo”lvement whether
unilateral or bilateral.
(3) These ohanges were much more manifest in cases
with definite caviation than those without.
(4) Also they were more manifest in cases of active
pulmonary tUberculosis with coexistent pregna~h~Y
or diabetes mellitus.
(5) Cases which had received previous antitubercuJ.ous
’treatment showed lesser changes tha.n genuine cases
presumably due to lesser activity of the tuberculous
process as a result of treatment.
(6) \”iith effective chemotherapy, these changes return
rapidly at first and then slowly. The electrophoretic
pattern of the serum proteins was within
normal in 9 - 12 months in all cases regardless
of the activity of the disease.
The Alb/~ andAiG ratios tended t 0 return to
normal within 9 months in all cases irrespective
of tho activity of the disease.
The total serum. polysaccharides tended 1;0 fall
rapidly at first and then slowly and it attained
a normal level in all cases within a year. Only
6 cases with persistent activity showed high
total serum polysaccharides, mild E.S~R changes
and a normal total serum proteins and electrophoretic
pattern 12 - 15 months after treatment.
(7) A persistent high serum polysaccharide denotee
a bad prognos is - 3 deaths were recorded in tn:: f’
group.
(8) With relapse, the changes in the total serum
polysaocharides appeared much earlier than those
of serum proteins or E.S.R.
(9) While the changes in the total serum polysaccharides
ran parra1el with the extent of pulmonarY
_”.involvement, no such relationship could be
detected with degree of tuberculin positivity.
(10) The mean erythrocyte sedimentation rate was raised
in all genuine cases and ran parralel with the
extant of the disease. It tended to fall rapidly
and some times was within the normal range in spite
of the activity of tbe disease.
(11) Electrophoretic separation of serum polysaccharides
showed a decidedly high alpha globulins at the· start
of treatment especially in cases with associated
diabetes mellitus.
; It returned gradually to
normal after treatment.
So the estimation of the total serum protaint,
total serum polysaccharides; their electrophoretic
patter and the mean erythrocyte sedimentation rat(,
may be of value in the determination of the aotivity
of the tUberculous process, extent, of disease and for
follow up of cases after effeotive chemotherapy.
A persistent elevation of serum polysaccharides denotes
continuous activity with a bad prognosis.