1Internal Medicine Residency, Summa Health/Northeast Ohio Medical University, Akron, Ohio
2Department of Biology, Miami University, Oxford, Ohio
3Infectious Disease Division, Department of Medicine, Summa Health, Akron, Ohio and Infectious Disease Section, Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio
1.1. Background: Numerous studies have documented a delay in diagnosis of pulmonary tuberculosis. We assessed the efficiency of the diagnosis and treatment of tuberculosis at our institution from 2010 to 2019.
1.2. Methods: Mycobacterial cultures were reviewed from January 1, 2010 to December 30, 2019. Patients with positive cultures for Mycobacterium Tuberculosis Complex (MTb) were recorded and all patients’ charts were reviewed. We recorded date, age, gender, race, country of origin, presenting symptoms, history of TB in patient/family, comorbidities, source of MTb culture, time from admission to recorded suspicion of TB (suspicion interval), time from suspicion to diagnosis (diagnostic interval), time from presentation to treatment (therapeutic interval), and outcome. Patients treated solely in outpatient setting were excluded.
1.3. Results: We identified 31 patients with TB from 2010-2019. 5 were diagnosed/treated in the outpatient setting, leaving 26 patients for analysis. Age range was 18-92 years (Mean=52 yrs.). There were 4 African Americans (1 foreign born), 6 Caucasians (1 foreign born), 16 Asians (16 foreign born). 12/26 (46%) had a history of latent TB and 1/26 (4%) had a history of treated active TB. Rapid presumptive diagnosis of TB was made within 72 hours of hospital admission in 17/26 (65%): 7 patients diagnosed with positive fluorescein AFB stains of sputum; 4 patients diagnosed with positive MTb PCR stains of sputum; 3 patients with positive MTb PCR stains of Bronchoalveolar Lavage (BAL) specimens; 2 patients with positive fluorescein AFB stains of BAL specimens; one patient with positive fluorescein AFB smear of hip joint aspirate; and one patient with positive AFB smear of lymph node biopsy. Mean suspicion interval=3.6 days; mean diagnostic interval=9.6 days; mean therapeutic interval=9.1 days. 21 patients survived and 3 patients died (2 unknown).
1.4. Conclusions: TB was more common from 2015-2019 than from 2010-2014. Providers recognized TB risk factors quickly, ordered appropriate diagnostic testing rapidly, and diagnosed and treated TB more quickly than anticipated. Physicians were extremely efficient in suspecting, diagnosing and treating active TB from 2010-2019 at our institution.
Tuberculosis, Diagnostic Delay, Diagnostic Accuracy
Cynthia Pung, Ian Kausch, Joseph Myers, Resurgence of Tuberculosis at a Large Community Teaching Hospital in the 21st Century – A Quality Improvement Project Evaluating Index of Suspicion, Diagnostic Acumen, and Treatment Efficiency of Tuberculosis from 2010 to 2019. Int Case Rep Jour. 2022;2(2):1-5.