Delays in diagnosis and treatment of pulmonary tuberculosis in AFB smear-negative patients with pneumonia
METHODS: This was a retrospective observational study. Patients with positive AFB culture of Mycobacterium tuberculosis complex (MTC) were selected from among hospitalised patients with a diagnosis of pneumonia. Admission ward, anti-tuberculosis treatment and the duration of AFB culture were compared between smear-positive and smear-negative patients.
RESULTS: Of the 70 patients with positive isolation of MTC in AFB culture, 27 (38.5%) were smear-negative; of these, 18 (66.7%) were not isolated while in hospital, and 17 (63%) were neither diagnosed nor treated for TB. In contrast, 41 of the 43 smear-positive patients (95.3%) were directly admitted or quickly transferred to the isolation room and started on anti-tuberculosis treatment (P < 0.001). Samples from smear-negative patients required more time to grow MTC in AFB culture than those of smear-positive patients (23 days vs. 14 days, P < 0.001). Diabetes was significantly associated with AFB smear positivity, with an odds ratio of 12.2.
CONCLUSIONS: Negative AFB smears caused significant diagnostic and treatment delay. Patients staying in the general ward were exposed to TB patients who were not diagnosed in time.
Keywords: AFB smear; pulmonary tuberculosis; severity; transmission
Document Type: Research Article
Affiliations: 1: Epidemiology Department Medical Board 2: Microbiology Department, Pathology 3: Infection Control, Singapore General Hospital, Singapore 4: University of British Columbia James Hogg Research Centre, Heart Lung Institute, St Paul's Hospital, Vancouver, British Columbia, Canada 5: Chief Executive Office 6: Medical Board, Singapore General Hospital, Singapore
Publication date: 01 May 2017
This article was made available online on 16 March 2017 as a Fast Track article with title: "Delays in diagnosis and treatment of pulmonary tuberculosis in AFB smear-negative patients with pneumonia".
The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.
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