Key determinants of misdiagnosis of tracheobronchial tuberculosis among senile patients in contemporary clinical practice: A retrospective analysis

Abstract

BACKGROUND Tracheobronchial tuberculosis (TBTB) is a common subtype of pulmonary tuberculosis. Concomitant diseases often obscure the diagnosis of senile TBTB. AIM To characterize senile patients with TBTB and to identify the potential causes of misdiagnosis. METHODS One hundred twenty patients with senile TBTB who were admitted to the Anhui Chest hospital between May 2017 and May 2019 were retrospectively analyzed. Patients were classified as diagnosed group ( n = 58) and misdiagnosed group ( n = 62). Clinical manifestations, laboratory results, radiographic data, and endoscopic findings were compared between the two groups. RESULTS Patients in the misdiagnosed group were most commonly diagnosed as pulmonary tuberculosis (non-TBTB, 29/62, 46.8%), general pneumonia (9/62, 14.5%), chronic obstructive pulmonary disease (8/62, 12.9%), and tracheobronchial carcinoma (7/62, 11.3%). The time elapsed between disease onset and confirmation of diagnosis was significantly longer in the misdiagnosed group [median (first quartile, third quartile): 6.32 (4.94, 16.02) mo vs 3.73 (2.37, 8.52) mo]. The misdiagnosed group had lower proportion of patients who underwent bronchoscopy [33.87% (21/62) vs 87.93% (51/58)], chest computed tomography (CT) scan [69.35% (43/62) vs 98.28% (57/58)], and those who showed CT signs of tuberculosis [27.91% (12/62) vs 50% (29/58)] as compared to that in the diagnosed group ( P < 0.05). There were no significant between-group differences with respect to age, gender, occupation, clinical manifestations, or prevalence of comorbid chronic diseases ( P > 0.05). CONCLUSION Insufficient or inaccurate radiographic or bronchoscopic assessment was the predominant cause of delayed diagnosis of TBTB. Increased implementation and better interpretation of CT scan and early implementation of bronchoscopy can help reduce misdiagnosis of senile TBTB.

Risk Factors for Pulmonary Tuberculosis with Tracheobronchial Tuberculosis: Propensity Score Matching Analysis

“… 11 TBTB is often misdiagnosed or delayed in clinical practice, primarily due to insufficient imaging and bronchoscopy evaluation. 12 Currently, bronchoscopy is an essential diagnostic method for TBTB, allowing for direct observation of tracheal lesions and determination of their type, location, range, and severity. The study of risk factors for PTB accompanied by TBTB can effectively guide clinical practice, and conducting bronchoscopy on high-risk patients can lead to accurate diagnosis and treatment.…”

Prevalence and Associated Factors of Chronic Obstructive Pulmonary Disease among Adults in Neno District, Malawi: A Cross-Sectional Analytical Study [Response To Letter]

“…We noted that there may have been an underdiagnosis of tuberculosis in the cohort causing or exacerbating COPD or misdiagnosis of COPD, which has been a noted limitation in other studies in a similar context. 3 , 4 However, most over-diagnosis of COPD in low resource settings is due to diagnosis without spirometry 5 which we used in this study. Granted, tuberculosis may be still underlying and in future studies additional screening and diagnosis of possible tuberculosis will be included.…”

Recognizing and addressing the challenges of gastrointestinal tuberculosis

“…However, bacteriologic confirmation is necessary to diagnose correctly and provide the most effective treatment[ 9 ]. But in some cases, despite intensive efforts, it may not always be possible to confirm the diagnosis of TB[ 39 ]. When clinical suspicion is highly in favor of TB, empirical antituberculosis treatment is a valid diagnostic and therapeutic option and remains an established tool in clinical practice[ 17 ].…”