Diagnostic and treatment delay in extrapulmonary tuberculosis and association with mortality: Experiences from Mbeya,...

Unlike pulmonary tuberculosis, there is limited information on delays in diagnosis and treatment initiation in extrapulmonary tuberculosis (EPTB) and their consequences for disease outcomes and mortality. In low- and middle-income countries, most EPTB cases are presumed rather than microbiologically confirmed, which might lead to an underestimation of the mortality rates in EPTB.

The study aimed to assess the delays in diagnosis and treatment in EPTB and their association with mortality in a setting with a high prevalence of both HIV and malnutrition.

We included 106 EPTB patients from Mbeya Zonal Referral Hospital, who were followed up until the completion of their treatment. Patients were classified as having EPTB using a clinical case definition. In total, 37 of 106 (35%) EPTB cases resulted in death. The median (interquartile range) total diagnostic delay for survivors was 59 days (26-136), while for those who died, it was 78 days (32-165). The corresponding median (interquartile range) treatment delay was 66 days (33-140) for survivors and 78 days (27-189) for those who died. None of the differences reached statistical significance when analyzed with non-parametric tests. Surprisingly, 21 patients did not receive TB treatment, but this lack of therapy did not affect mortality or correlate with a longer diagnostic delay.

We were unable to demonstrate that diagnostic or treatment delays were higher in EPTB patients who died. Furthermore, EPTB patients who did not receive TB treatment did not exhibit higher mortality rates. Further prospective studies with larger sample sizes are needed to better understand the factors contributing to delays in diagnosis and treatment, as well as their potential impact on mortality in EPTB.