title: Time from symptom onset to the initiation of treatment of pulmonary tuberculosis in a city with a high incidence of the disease.
abstract: OBJECTIVE
  To estimate the time elapsed between the onset of symptoms and the initiation of treatment of pulmonary tuberculosis among treatment-naïve patients with positive results in sputum smear microscopy, and to evaluate the variables associated with delays in diagnosis and in treatment initiation.
  
  
  METHODS
  This was a descriptive exploratory study involving 199 treatment-naïve tuberculosis patients > 12 years of age with AFB-positive sputum smear microscopy results between 2006 and 2008. At their first (treatment initiation) visit to a primary health care clinic in the city of Nova Iguaçu, Brazil, the patients were interviewed and their ancillary test results were reviewed.
  
  
  RESULTS
  The medians (and respective interquartile ranges) of the time from symptom onset to the initiation of treatment of pulmonary tuberculosis, from symptom onset to seeking medical attention, from entry into care to diagnosis, and from entry into care to treatment initiation, in weeks, were 11 (6-24), 8 (4-20), 2 (1-8), and 1 (1-1), respectively. The variables gender, age, level of education, previous use of antibiotics, HIV status, site of first medical visit, and radiological extent of tuberculosis showed no associations with the time from entry into care to diagnosis and to treatment initiation. The main reason for the delay in seeking medical attention reported by the patients was their inability to recognize their symptoms as indicators of a disease.
  
  
  CONCLUSIONS
  Among the patients studied, there was an unacceptably long delay between the onset of symptoms and the initiation of tuberculosis treatment.
authors.affiliation: Federal University of Rio de Janeiro Thoracic Diseases Institute, Rio de Janeiro, RJ, Brasil.
authors.forename: Marina de Loureiro
authors.initials: Mde L
authors.lastname: Maior
authors.forename: Renata Leborato
authors.initials: RL
authors.lastname: Guerra
authors.forename: Michelle
authors.initials: M
authors.lastname: Cailleaux-Cezar
authors.forename: Jonathan Eric
authors.initials: JE
authors.lastname: Golub
authors.forename: Marcus Barreto
authors.initials: MB
authors.lastname: Conde
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D057210:Delayed Diagnosis; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D012959:Socioeconomic Factors; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents