Lysozyme level of pleural fluid.

Lebowitz MD, et al. Collaborative study to assess risk of lung disease in Pi MZ phenotype subjects. We read with interest the article by Farman and Speirl in which they stated that atypical roentgenographic presentation of lung tuberculosis is still uncommon in adults. This is in contrast with other studies2-5 in which an increased frequency of unusual presentations similar to those in childhood are described (especially in older patients) and are attributed to the fact that these patients have outlived their initial infecting mycobacteria and become more susceptible to exogenous reinfection. We reviewed the chest x-ray films from 114 adult patients with bacteriologically-proven lung tuberculosis diagnosed between 1981 and 1985. We made a subdivision between "usual postprimary tuberculosis" consisting of infiltrations (with or without cavitation) in the apicoposterior segments of the upper and/or lower lobes whether or not these were associated with other lesions, and "unusual" localisations without even minor inactive sequellae in the apicoposterior zones on tomographs (Table). We found no difference in presentation between patients younger vs older than 60 years of age (Table). Our findings were in agreement with those of Farman and Speirl and Hadlock et al,6 but in contrast with others.24 We conclude that, in our country, endogeneous reactivations remain the main pathogenic pathway in the elderly The difference between the published studies may at least partly be attributed to sometimes arbitrary differences in classification as usual or unusual form. We therefore agree with Kovnat7 that the importance of a uniform classification should be stressed.