Rouillon A, Perdrizet S, Parrot R
Tubercle. 1976 Dec;57(4):275-99. doi: 10.1016/s0041-3879(76)80006-2.
The important differences in the infectivity of the various forms of tuberculosis can be explained by quantitative data concerning the behaviour of the tubercle bacillus in man and the number of bacilli in the lesions and sputum. Patients in whom tubercle bacilli can be detected by direct examination of the sputum smear are the main sources of transmission. Moreover the individuals infected by them break down more often with the disease. In the individual patient, the use of antibacterial drugs completely changes the natural history of the disease: not only do patients no longer die but they are cured; their period of infectivity is considerably reduced, relapses are avoided, chronicity disappears. The drugs used prophylactically in individuals of high risk groups prevent development of the disease. The impact of chemotherapy is reflected by a two-to-three-fold increase in the speed of decline of the risk of infection, a decline which had started before the introduction of the drugs. While patients given the right combination of drugs lose their infectivity in a few weeks (probably most often in less than two weeks), treatment must of course be continued much longer and regularly in order to ensure the maintenance of conversion and the absence of relapse. This stresses the importance of providing means to ensure the taking of the drugs by all patients. The future reduction of transmission will essentially depend on the maintenance of an adequate system ensuring the early diagnosis and correct treatment of cases, which will inevitably continue to appear among the already infected portion of the population. Epidemiological surveillance is mandatory as well as the surveillance of the delivery of services, particularly of the quality of diagnosis and therapeutic services. The roles of public health authorities and perhaps still more that of the practising physician, specialized and not specialized, remain considerable both from an epidemiological point of view and from the point of view of the relief of all the suffering still created by the disease.
各种形式的结核病在传染性方面的重要差异，可以通过有关结核杆菌在人体内行为的定量数据以及病变和痰液中杆菌数量来解释。通过直接检查痰液涂片就能检测到结核杆菌的患者是主要的传染源。此外，被他们感染的个体更易发病。对于个体患者而言，使用抗菌药物完全改变了疾病的自然史：患者不仅不会死亡，而且能够治愈；他们的传染期大幅缩短，避免了复发，慢性病状也消失了。在高危人群中预防性使用的药物可预防疾病的发生。化疗的影响体现在感染风险下降速度提高了两到三倍，这种下降在药物引入之前就已开始。虽然给予正确药物组合的患者在几周内（可能大多数情况下不到两周）就会失去传染性，但为确保维持转阴状态且不复发，治疗当然必须持续更长时间且要规律进行。这凸显了提供手段确保所有患者服药的重要性。未来传播的减少将主要取决于维持一个适当的系统，以确保对病例进行早期诊断和正确治疗，而在已感染人群中不可避免地会继续出现病例。流行病学监测以及对服务提供情况的监测，特别是对诊断和治疗服务质量的监测是必不可少的。从流行病学角度以及从减轻该疾病仍造成的所有痛苦的角度来看，公共卫生当局的作用，或许更重要的是执业医生（无论是否专科）的作用仍然十分重要。
