[Analysis of the diagnostic delay in tuberculosis].
OBJECTIVE
To identify the situations that influence in the delayed diagnosis of tuberculosis.


METHODS
We studied 109 patients (87 non HIV-infected and 22 HIV-infected) who were diagnosed of tuberculosis in one year consecutively, using a questionnaire to obtain time intervals in which the whole diagnostic delay (WD) was divided.


RESULTS
WD was higher than 1 month in 90 % of non HIV-infected patients. The delay due to the health system (SD) was higher (71% > 1 month) than the delay due to patient (PD; 30% > 1 month) and there was a negative correlation between both (R-0.73). In HIV+ group, WD was lower (59.1% > month) and, although PD was higher (40.9% > 1 month), the time that the system delayed the suspicion of the diagnosis was lower (5.5% > 1 month). In HIV-group there were the following significant differences: higher delay in the suspicion of diagnosis (DSD) (61.4% and 60.8% > 1 month) and shorter time to make the diagnosis (12.3% and 21.6% > 1 month) in sputum smear-positive patients and who had cavitary lesions; PD was higher (67.1% > 1 month) in patients with general symptoms and nearly none in patients with upper airways symptoms; and higher DSD in presence of nonspecific symptoms like cough or/and expectoration (68.6% > 1 month) or upper airways symptoms (100% > 1 month). As these clinical symptoms were consulted in primary care mainly, there was a higher SD (75.75 > 1 month) and DSD (58.1% > 1 month), and were increased when a promptly chest X-ray was not performed (87.1 and 68.7% > 1 month).


CONCLUSIONS
Delayed diagnosis of tuberculosis is common. In non HIV-infected patients, it occurs mainly in the health system. Diagnostic delays contribute to raise advanced disease with more contagious potential.
Franco
J
J
Servicio de Neumología, Hospital Dr. Peset, Valencia.
Blanquer
R
R
Flores
J
J
Fernández
E
E
Plaza
P
P
Nogueira
J M
JM
D000328:Adult; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis*