Risk factors for the delayed diagnosis of extrapulmonary TB

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Background:

• Extrapulmonary tuberculosis (EPTB) presents diagnostic challenges compared to pulmonary TB.
• Delayed EPTB management can result in severe complications and increased societal costs.

Purpose of the Study:

• To identify risk factors contributing to delayed diagnosis and treatment of extrapulmonary tuberculosis.
• To differentiate factors influencing early versus delayed EPTB diagnosis.

Main Methods:

• Retrospective analysis of 594 newly diagnosed EPTB patients across 11 South Korean general hospitals (Jan 2017–Dec 2018).
• Univariable and multivariable analyses compared early and delayed diagnosis groups to pinpoint risk factors.
• Patient characteristics and diagnostic test positivity were examined.

Main Results:

• Lymph node TB was the most common form (28.3%), followed by abdominal (18.4%) and disseminated TB (14.5%).
• Early diagnosis was linked to acute symptoms in disseminated, pericardial, and meningeal TB, and immunosuppression.
• Delayed diagnosis correlated with outpatient visits, delayed sample acquisition, and non-specialized diagnostic departments.

Conclusions:

• Diagnosis delays in EPTB are primarily attributed to indolent clinical presentations, leading to non-specialized care.
• Referral to non-TB-specialized departments and delayed diagnostic testing contribute significantly to EPTB treatment delays.
• Microbiological characteristics of Mycobacterium tuberculosis did not appear to influence diagnostic timelines.