Clinical and roentgenographic manifestations of pulmonary tuberculosis in adults in Papua New Guinea.

The clinical and roentgenographic manifestations of newly confirmed cases of pulmonary tuberculosis at Port Moresby General Hospital during a one year period, starting May 1st, 1977, were reviewed. Of 402 adult patients who were commenced on anti-tuberculosis drugs during this period 101 had bacteriologically confirmed pulmonary tuberculosis. A history of chronic productive cough was the most common clinical finding. Extrapulmonary involvement was found in one third of the patients. Family history of tuberculosis was positive in 20%. There were 50 patients with one or both upper lobes involved, 20 with miliary, 9 with pleural effusion, 5 with generalized by non-miliary pattern, 5 with lower lobes, and one with primary tuberculosis. No tuberculoma was found and the chest x-ray was normal in 2 patients. The most common pattern was involvement of both upper lobes (31 patients). One or more cavities were present in more that half of the patients. In 13% of the patients, roentgenographic findings were considered atypical for adult pulmonary tuberculosis. Cases of lower lung field tuberculosis were the most difficult to diagnose. Comparing the result of this study with that of similar series from countries with a low prevalence of tuberculosis shows that there is a higher frequency of miliary pattern and a lower frequency of tuberculoma and primary tuberculosis in papua New Guinea adults.