Tuberc Respir Dis.  1968 Jun;15(2):23-26. 10.4046/trd.1968.15.2.23.

Camouflaged Tuberculosis -Tuberculosis beginning with Psychoneurotic Syndrome

• KMID: 2529188
• DOI: http://doi.org/10.4046/trd.1968.15.2.23

Abstract

Introduction
It is well known that the initial symptoms of pulmonary tuberculosis are slight fever, cough and sputum or hemoptysis, even though we often find asymptomatic patients. On the other hand, it was also reported previously by Pottenger & Pagel that some patients complain of neurotic symptoms in the beginning of tuberculosis. The following patient with whom the author has had experience in the past, maybe presented as a possible case of this condition. the patient suffered from insomnia and pain in the shoulder in July '55. Chest x-ray and laboratory tests including sputum examination showed no pathological changes. The patients was diagnosed as neurosis by his attending doctor at that time. A 2nd chest x-ray was taken in November '56 and revealed small densities in both upper lung fields. Many efforts have been made by prof. KOGA, Jikeikai School of Medicine, the establish the diagnosis of early tuberculosis beginning with neurotic symptoms so-called "Koga's Camouflaged tuberculosis" before showing abnormalities on the chest x-ray & sputum examination. This research has obtained successful results recently. Mechanism The neurotic symptoms in the beginning of early tuberculosis are explained as one of Selye's " General Adaptation Syndrome." Selye reported that in the presence of emotional stress or other factors, the adrenal cortex excretes corticoid hormones. this phenomenon results in disharmony in the vegetative nerve system and brings various symptoms. Infection from tubercles such as fever, easy fatiguability or neurotic symptoms in the early stage of tuberculosis are a general adaptation syndrome. At Koga's clinic, experimentally they demonstrated ad conspicuous image of hyperfunction of the federal cortex of rats under emotional street by the device of "Setting Cat on Rat". Also another encouraging result was reported from the clinic concerning tubercle bacilli inoculation into the abdominal cavity of guinea pigs. Diagnosis & Treatment Modern method of diagnosis for tuberculosis such as chest x-ray sputum examination are not satisfactory to find so-called camouflaged tuberculosis. The most important method is the examination of eye fundus to find chronic retrobulbar optic neuritis. Many theories have been reported about the cause of optic neuritis. Dr. Saigo. Koga clinic, reported 70% of optic neuritis among 80 patients suspected of so-called camouflaged tuberculosis. A late experimental report concerning eletromicroscopic findings fo the optic nerve after B.B.G. Inoculation into the abdominal cavity of mouse was encouraging. As to the treatment there is no difference between tuberculosis and so-called Camouflged tubervulosis.