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The Untimely Misfortune of Tuberculosis Diagnosis at Death: Twelve-Year Experience at an Urban Medical Center

Barragán, Maribel MPH*; Holtz, Meredith MD*; Franco-Paredes, Carlos MD, MPH*†; Leonard, Michael K. MD*

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e3181f744a7
Original Articles
Abstract

Introduction: Most of the burden of tuberculosis (TB) in the United States resides in underserved minorities in the inner city. Prompt diagnosis and initiation of therapy are crucial.

Methods: We performed a retrospective review for a 12-year period of a major inner city hospital in the United States to identify cases of TB diagnosed at the time of death or postmortem.

Results: We identified 35 cases for a 12-year period. Of these, 33 (94%) were culture-confirmed cases of TB. At the time of autopsy, 6 cases (17%) were identified. In all these cases, there was no clinical suspicion of TB. Pulmonary TB was confirmed in 27 (77%) of the 35 patients, whereas 8 (23%) of the 35 had extrapulmonary TB. Of those with extrapulmonary TB, 6 patients had disseminated TB; 1, peritoneal TB; and 1, meningeal TB.

Discussion: Clinicians serving underserved populations with high human immunodeficiency virus infection/ acquired immune deficiency syndrome prevalence or other comorbidities such as diabetes and/or with currently high TB prevalence rates and high clinical suspicion of acute disseminated forms of TB even without bacteriologic confirmation, a therapeutic trial of antituberculous drugs should be entertained among those patients in whom there is strong clinical suspicion.

Author Information

From the *Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA and †Hospital Infantil de Mexico, Federico Gomez, Mexico City, Mexico.

Correspondence to: Carlos Franco-Paredes, MD, MPH, Division of Infectious Diseases, Emory University, MOT 7th Floor, 550 Peachtree St, Atlanta, GA 30308. E-mail: cfranco@emory.edu.

The authors have no funding or conflicts of interest to disclose.

© 2011 Lippincott Williams & Wilkins, Inc.