Undiagnosed Tuberculosis in Hospitalized Patients

Katz, Ian; Rosenthal, Talma; Michaeli, D

doi:10.1378/chest.87.6.770

Cited by 72 publications

(34 citation statements)

References 25 publications

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“…In-hospital mortality rate remains high at y60%, for patients with active pulmonary TB and respiratory failure [4][5][6][7][8][9][10]. This is twice as high as the mortality rate of patients with pneumonia requiring mechanical ventilation [4,11,12].Delays in the diagnosis and treatment of pulmonary TB have been recognised as the main causes of death [2,4,8,[13][14][15][16]. Several studies have sought to reduce these delays by identifying factors that lead to a high index of suspicion [4,8,[13][14][15][17][18][19][20].…”

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Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation

Lee¹,

Jerng²,

Chang³

et al. 2003

Eur Respir J

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Mortality remains high among patients with pulmonary tuberculosis requiring mechanical ventilation (TBMV). This study was carried out to establish the mortality rates of TBMV and to identify factors that contribute to in-hospital mortality.From January 1996-April 2001, there were 825 patients with active pulmonary tuberculosis at the National Taiwan University Hospital, Taipei, Taiwan. Of these, 41 suffered acute respiratory failure and required mechanical ventilation in the intensive care unit (ICU). Of these 41 patients, 38 were followed up for 180 days. In-hospital deaths were documented in the medical records and all possible parameters contributing to mortality were collected.Of the 41 patients, 27 died in the hospital and 14 were discharged alive (in-hospital mortality rate 65.9%), with (mean¡SD) 40.7¡35.4 admission days before death. Of the 27 that died, 25 died during ICU admission and two died after being transferred to the ward. The mortality rate for the 180-day monitoring period was 79%. Factors contributing to in-hospital mortality included consolidations on chest radiographs and multiple organ failure.The mortality rate in the patients with pulmonary tuberculosis requiring mechanical ventilation is very high, with two factors affecting in-hospital mortality. These factors were multiple organ failure and consolidation on chest radiographs. In 2000, an estimated 8 million people were infected and 2 million people died of tuberculosis (TB) worldwide [1][2][3]. Despite advances in chemotherapy, cases of pulmonary TB and TB-related critical illness increased dramatically over the last few decades. In-hospital mortality rate remains high at y60%, for patients with active pulmonary TB and respiratory failure [4][5][6][7][8][9][10]. This is twice as high as the mortality rate of patients with pneumonia requiring mechanical ventilation [4,11,12].Delays in the diagnosis and treatment of pulmonary TB have been recognised as the main causes of death [2,4,8,[13][14][15][16]. Several studies have sought to reduce these delays by identifying factors that lead to a high index of suspicion [4,8,[13][14][15][17][18][19][20]. The reasons for delays in diagnosis include the failure to perform appropriate diagnostic investigation and the misinterpretation of radiological or clinical manifestations as malignancy, pneumonia or other conditions [4,8,[13][14][15][17][18][19][20][21][22].Reports of active pulmonary TB with acute respiratory failure are not scarce, but few focus on mechanically ventilated patients. Such patients have a higher mortality rate than patients who do not need mechanical ventilation [4-6, 8, 10]. However, w50% of the patients included in these previous studies were positive for human immunodeficiency virus (HIV) infection. Hence, conclusions derived from these studies may not apply to HIV-negative patients.Therefore, the authors conducted a retrospective study with three objectives in relation to active pulmonary TB patients requiring support by mechanical ventilation (TBMV). These object...

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“…Delays in the diagnosis and treatment of pulmonary TB have been recognised as the main causes of death [2,4,8,[13][14][15][16]. Several studies have sought to reduce these delays by identifying factors that lead to a high index of suspicion [4,8,[13][14][15][17][18][19][20].…”

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confidence: 99%

Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation

Lee¹,

Jerng²,

Chang³

et al. 2003

Eur Respir J

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“…Even in co-infection, such as with HIV, occurrence of TB could be a difficulty creating diagnostic complacency. Extra pulmonary TB is another state where its diagnosis can be missed as it manifests in other organs or sites of the body [12] .In many of the cases, the case of TB is also overlooked by the physicians that are mostly being attributed to lack of diagnostic facilities, inadequate investigation of the ailment and physician's specialization [13].…”

Section: Barriers To Case Detection and Diagnosismentioning

confidence: 99%

TB: Barrier in access, diagnosis and treatment completion

Marahatta

Shrestha

Bhattarai

et al. 2016

J. Manmohan Memorial Inst. Health. Sci.

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Tuberculosis (TB) is a major public health concern for Nepal like many other developing countries around the world. Economic barrier is one of the major problems in poor and marginalized population. Poor people mostly remain unaware of the treatment facilities and some find it difficult in seeking T.B treatment as they don’t trust the program and most of them don’t possess enough knowledge about the disease itself. Population residing in the remote areas of the countries can’t access the treatment facilities due to far distance of health facilities from there residence due to lack of roads and lack of transport. Thus difficult geography primarily in rural areas in the country acts as a barrier to access the health facility. TB infection faces add-on challenge with the advent of co-infection and possibility of increase in drug resistant TB. This is why detecting TB in its early stage would pose a number of advantages to the patient that would in turn help for early treatment. However, the challenges and barriers in early diagnosis remain that is being contributed by multifaceted factors. The lack of knowledge coupled with poor financial capacity to pay for the diagnosis especially in rural population prevents them from being diagnosed properly as well. Factors for not completing the treatment are when patient starts feeling better, lack of drugs, major side effects of the drugs and inadequate knowledge about advantages of completion of the drug treatment. The attitude of the hospital staff also in many cases leads to discontinuation of the treatment. Patient who have limited income and got financial support from their relatives explained about treatment going above their obtainable resources leading to early withdrawal from the treatment completion. Geography is one of the important issues for treatment completion as routine drug administration follow up in patient (farther from particular distance) is difficult and leads to exhaustion and withdrawal from the treatment.Journal of Manmohan Memorial Institute of Health Sciences Vol. 2 2016 p.76-80

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“…Even in co-infection, such as with HIV, occurrence of TB could be a difficulty creating diagnostic complacency. Extra pulmonary TB is another state where its diagnosis can be missed as it manifests in other organs or sites of the body [6,7]. In many of the cases, the case of TB is also overlooked by the physicians that are mostly being attributed to lack of diagnostic facilities, inadequate investigation of the ailment and physician's specialization [8].…”

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Tuberculosis in Nepal: Diagnosis and Treatment Barriers

Marahatta

Karki

2016

J. Manmohan Memorial Inst. Health. Sci.

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Tuberculosis (TB) is a major public health concern for Nepal like many other developing countries around the world. The incidence of TB in Nepal according to World Bank is 158 per 100,000 people. On the other hand, the case detection rate for all forms of TB in Nepal is only about 79% [1]. The cases that are not notified and detected are not enrolled for Directly Observed Treatment Short course (DOTS) therapy. They do not get adequate treatment and remain infectious, increasing the TB affected patient load of the country.Treatment of TB is free of cost by Government of Nepal. DOTS are composed of five distinct elements: political commitment; microscopy services; drug supplies; surveillance and monitoring systems and use of highly efficacious regimens; and direct observation of treatment. Government provides DOTS service in Nepal through DOTS treatment centers and sub-centers.A simple rule is that early diagnosis of TB leads to early treatment. As the treatment gets delayed, the severity of the disease and difficulty in recovery process becomes complicated. As being one of the major public health problems in Nepal, halting and decreasing TB infection faces add-on challenge with the advent of co-infection and possibility of increase in drug resistant TB [2]. This is why detecting TB in its early stage would pose a number of advantages to the patient that would in turn help for early treatment. However, the challenges and barriers in early diagnosis remain that is being contributed by multifaceted factors.On study showed that in Nepal patients resort to number of providers and institutions before being diagnosed properly for TB [3]. In addition, they spent long period of time (sometime years) before being diagnosed properly. This is specifically due to the fact that patients usually resort to institutions or facilities that lack proper arrangement for TB diagnosis such as pharmacies and informal health care settings. The lack of knowledge coupled with poor financial capacity to pay for the diagnosis [4] especially in rural population prevents them from being diagnosed properly as well.Moreover, the disease (TB) could mimic other diseases making the case typical or atypical which in turn make it difficult for physicians and health workers in its proper diagnosis [5]. Even in co-infection, such as with HIV, occurrence of TB could be a difficulty creating diagnostic complacency. Extra pulmonary TB is another state where its diagnosis can be missed as it manifests in other organs or sites of the body [6,7]. In many of the cases, the case of TB is also overlooked by the physicians that are mostly being attributed to lack of diagnostic facilities, inadequate investigation of the ailment and physician's specialization [8].Given the complexity of the disease, Nepal remains ill prepared to tackle the issues related with early diagnosis of TB. From the lack of preparedness of health system especially in rural areas, poor socioeconomic status of majority of the people, to the lack of awareness and knowledge regarding TB [9] m...

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Undiagnosed Tuberculosis in Hospitalized Patients

Cited by 72 publications

References 25 publications

Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation

Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation

TB: Barrier in access, diagnosis and treatment completion

Tuberculosis in Nepal: Diagnosis and Treatment Barriers

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