Delayed inpatient diagnosis and isolation of active pulmonary tuberculosis patients, a large tertiary care academic hospital experience in Riyadh, Saudi Arabia

Abstract

Objectives: To identify pulmonary tuberculosis (PTB) delayed inpatient diagnosis duration and contributing factors in an academic center in Saudi Arabia (SA). Methods: Retrospective review of all cultureconfirmed PTB cases between May 2015 and April 2019. The outcomes were the timing between admission and suspicion of PTB or isolation to either: early group (within 24 hours of admission) and late group (24 hours after admission). Original Article Results: Forty-nine cases were included with a median age of 49 years; a third of them were above 65 years of age. Most patients were of Saudi nationality and male. Approximately 38% of the cases were in the delayed group, half of them were smear-positive, with an average delay of 5.5 days. This was significant with: age above 65 years (odds ratio [OR]=8.93, 95% confidence interval [CI]=2.22-35.95) presence of non-respiratory symptoms (OR=5.6, 95% CI=1.56-19.98), malignancy (OR=13.38, 95% CI=1.46-122.71), chronic medical problems (OR=4.90, 95% CI=1.31-18.32), missed chest x-ray findings (OR= 48, 95% CI=8.63-266.88) or procalcitonin level above 0.5 ng/mL (OR=12, 95% CI=1.58-91.08). Conclusion: Physicians in SA need to have a low threshold for PTB consideration in elderly patients or those with a history of malignancy. A careful review of the initial chest x-ray might help to overcome missing cases of PTB.

Predictive Factors and Clinical Impacts of Delayed Isolation of Tuberculosis during Hospital Admission

“…Several studies have presented the risk factors for the delayed isolation of TB. Commonly suggested risk factors include old age [ 8 , 9 ] and admission to departments other than the pulmonology or infection department [ 10 , 11 ]. Presence of symptoms can be an important indicator for clinicians to suspect TB.…”