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Related Experiment Videos

Active tuberculosis undiagnosed until autopsy

I D Bobrowitz

    The American Journal of Medicine
    |April 1, 1982
    PubMed
    Summary
    This summary is machine-generated.

    Undiagnosed tuberculosis, particularly miliary tuberculosis, caused 21 deaths. Key factors like medical history and persistent lung infiltrates, even with negative tests, suggest tuberculosis and warrant a treatment trial.

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    Area of Science:

    • Medicine
    • Infectious Diseases
    • Pulmonology

    Background:

    • Tuberculosis (TB) is a significant cause of mortality, often diagnosed post-mortem.
    • Miliary and pulmonary TB are common forms leading to death.
    • Delayed diagnosis hinders effective treatment and patient outcomes.

    Purpose of the Study:

    • To review cases of fatal tuberculosis initially undiagnosed until autopsy.
    • To identify clinical and diagnostic factors that could have aided earlier TB diagnosis.
    • To emphasize the importance of considering TB in specific patient populations and presentations.

    Main Methods:

    • Retrospective review of 21 autopsy cases where tuberculosis was the primary cause of death.
    • Analysis of patient histories, clinical presentations, and diagnostic test results.

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  • Evaluation of factors potentially overlooked in antemortem diagnosis.

    • Main Results:

    • 11 deaths were due to pulmonary TB, 10 to miliary TB.
    • Factors like family history, prior pleurisy, gastrectomy, diabetes, and renal failure were associated with increased TB risk.
    • Negative tuberculin skin tests, inadequate sputum examination, and negative bone marrow aspirates did not rule out active or miliary TB.
    • Persistent lung infiltrates despite antibiotics, high fever, anemia, and leukopenia were strong indicators.
    • Miliary TB can mimic adult respiratory distress syndrome.

    Conclusions:

    • Tuberculosis, especially miliary TB, should be considered in fever of unknown origin.
    • Clinical suspicion, supported by risk factors and imaging, is crucial for diagnosis.
    • A therapeutic trial of anti-TB drugs is recommended when suspicion is high, even without bacteriologic confirmation.