Diagnosis of active tuberculosis in a university hospital

Active tuberculosis was diagnosed in 100 patients at Sunnybrook Medical Centre during the five-year period 1968-72. These cases were studied to find out if any delay had taken place in establishing the diagnosis and starting treatment. Delay was found most frequently when patients presented with atypical disease or when microbiological investigations were negative or misinterpreted. However, in nine patients with positive Ziehl-Neelsen smears the diagnosis was delayed more than one week. Usually such delays were caused by a failure to send specimens promptly for examination for acid-fast bacilli. Lack of communication between the laboratory and the clinician was found to be responsible for delays in starting treatment in several patients. It is essential that the clinician in a general hospital be alert to the possibility of tuberculosis and that there be close cooperation between the clinical staff and the diagnostic services.