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Factors associated with delayed diagnosis of tuberculosis in hospitalized patients in a high TB and HIV burden setting: a cross-sectional study

DOI: 10.1186/1471-2334-12-57

Keywords: Tuberculosism, Diagnostic delay, Treatment delay, Risk factors

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Abstract:

We conducted a cross-sectional study in a general, tertiary care, university-affiliated hospital. Adult patients with TB that were hospitalized were identified retrospectively, and risk factors for delayed diagnosis were collected.The median delay until diagnosis was 6 days (IQR: 2-12 days). One hundred and sixty six (54.4%) patients were diagnosed ≤ 6 days, and 139 (45.6%) > 6 days after admission. The main factors associated with diagnostic delay (> 6 days) were extra-pulmonary TB and negative sputum smear.Although hospitalization permits a rapid management of the patient and favors a faster diagnosis, we found an unacceptable time delay before the diagnosis of pulmonary TB was made. Future studies should focus on attempt to explain the reasons of diagnostic retard in the patients with the characteristics related to delay in this study.Tuberculosis (TB) is a major public health issue worldwide, particularly in low- and middle-income countries. It is estimated that one third of the world population is infected with Mycobacterium tuberculosis [1]. Brazil is ranked 19th among the 22 high-burden countries that collectively account for 80% of TB cases globally, with an incidence of 37.9 cases/100,000 inhabitants/year in 2009 [2]. The city of Porto Alegre, in southern Brazil, has the highest incidence of TB (109.4 cases/100,000 inhabitants/year in 2010) and TB-HIV coinfection (35%) in the country [3].The most essential components of TB control are early diagnosis and adequate treatment. It is estimated that a single infectious person who remains untreated can infect between ten and fifteen people every year, spreading the infection in the community [1,4]. In addition, delay in the diagnosis and treatment of tuberculosis may result in more extensive disease and more complications, increases severity of the disease and is associated with higher risk of mortality [5-7]. According to 2 studies, the main factors associated with diagnostic delay included HIV infection, negati

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