Korean J Intern Med.  2021 Mar;36(Suppl 1):S151-S159. 10.3904/kjim.2019.435.

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

• Kwak SH
• Choi JS
• Lee EH
• Lee SH
• Leem AY
• Lee SH
• Kim SY
• Chung KS
• Jung JY
• Park MS
• Kim YS
• Chang J
• Kang YA

• KMID: 2513823
• DOI: http://doi.org/10.3904/kjim.2019.435

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 polymerase 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.

Keyword

Lung disease; Tuberculosis; Diagnosis; Risk factors