Experience with tuberculosis in a public teaching hospital

Over a five-year period, 108 patients with active tuberculosis were admitted to the Talmadge Memorial Hospital in Augusta, Georgia. The age, sex and race distribution, case-fatality ratio, and primary drug resistance data did not differ from the national experience. The high incidence of nonpulmonary infection sites (31 percent) serves to emphasize that all hospital services and medical specialities can expect to encounter active tuberculosis. The only detected cluster of cases was from the state prison. The fact that the disease was not diagnosed or managed effectively in seven of 12 inmates emphasizes its special problem. Delays in diagnosis seemed to be unjustified in 11 patients; seven of these delays resulted from remediable human error. Four delays in diagnosis were due to difficulties that could be corrected by maintaining a greater awareness of tuberculosis and broadening the differential diagnosis to include tuberculosis among patients at high risk.