Streptomycin in the treatment of miliary and meningeal tuberculosis based on a study of 30 cases.

Whether acute hematogenous dissemination of tubercle bacilli results in miliary tuberculosis, tuberculous meningitis, or a combination of the two, the ensuing diseases, though very closely related etiologically, are nevertheless distinct clinical entities, each with a different prognosis and therapy. The immediate mechanism, which is responsible for the infection assuming one or the other clinical form, is a matter of speculation and may be due to a variety of causes such as: the anatomical position of the primary source of dissemination, the amount of infected material thrown into the circulation, the frequency of disseminations, possibly the vaguely understood individual variation in organ susceptibility, the patients’ general resistance, or a combination of these and other causes. An answer to this question, which may supply the key to prevention and, perhaps, to more successful therapy, must await further study. The reported results of treatment of acute disseminated tuberculosis with streptomycln have varied greatly. Only certain types of miliary disease (probably of a predominant local pulmonary type) have responded with any degree of permanent success.