Characteristics and risk factors associated with missed diagnosis in patients with smear-negative pulmonary tuberculosis

Se Hyun Kwak, Ji Soo Choi, Eun Hye Lee, Su Hwan Lee, Ah Young Leem, Sang Hoon Lee, Song Yee Kim, Kyung Soo Chung, Ji Ye Jung, Moo Suk Park, Young Sam Kim, Joon Chang, Young Ae Kang

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aims: Delayed diagnosis and treatment of smear-negative pulmonary tuberculosis (TB) are major concerns for TB control. We evaluated characteristics of patients with smear-negative pulmonary TB who received a delayed diagnosis and identified risk factors that may have contributed to this delay. Methods: We reviewed medical records of patients with smear-negative culture-positive pulmonary TB treated at a tertiary care hospital in South Korea between January 2017 and December 2018. Patients who initiated anti-TB treatment after positive cultures were included in the missed TB group, and those who initiated empirical treatment before positive cultures were included in the control group. Results: Of 220 patients included, 117 (53.2%) and 103 (46.8%) were in the missed TB and control groups, respectively. Patients in the missed TB group were older (p = 0.001) and had a higher mean body mass index (BMI) (p = 0.019). Comorbidities (66.9% vs. 46.6%, p = 0.003) and immunocompromised patients (33.1% vs. 20.4%, p = 0.035) were more common in the missed TB group than in the control group. Old age (odds ratio [OR], 1.030; 95% confidence interval [CI], 1.012 to 1.048; p = 0.001), high BMI (OR, 1.114; 95% CI, 1.004 to 1.237; p = 0.042), and negative poly-merase chain reaction (PCR) results (OR, 9.551; 95% CI, 4.925 to 18.521; p < 0.001) were associated with delayed diagnosis. Conclusions: In more than half of patients with smear-negative pulmonary TB, the diagnosis was delayed. Patients with delayed TB diagnosis were older, had higher BMI, and negative PCR results.

Original languageEnglish
Pages (from-to)S151-S159
JournalKorean Journal of Internal Medicine
Volume36
DOIs
Publication statusPublished - 2021

Bibliographical note

Publisher Copyright:
© 2021 The Korean Association of Internal Medicine.

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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