Why do our patients die of active tuberculosis in the era of effective therapy?

All patients with tuberculosis as a primary or underlying cause of death who were autopsied at the Institute for Lung Diseases and Tuberculosis, Sremska Kamenica, in the former Yugoslavia, between 1981 and 1990 were investigated.

To study why people die of active tuberculosis in the era of effective chemotherapy and to identify factors contributing to death.

In a retrospective investigation, this index group was compared with a control group consisting of patients who suffered from tuberculosis over the same period but who improved and were discharged from hospital.

A significant difference in age (P < 0.05) was found between those patients who died with an antemortem-established diagnosis and those who died with unrecognised tuberculosis (median 49 and 60 years respectively). When it came to the index group, 28 patients (56%) had one or more risk factors and the frequency of alcohol abuse was significantly higher (P < 0.001). Antituberculosis treatment had been introduced in 27 cases (54%). The median duration of hospitalization before therapy was 2 days and the median duration of antituberculosis therapy was 7 days. Of the 23 untreated tuberculosis patients, 74% died within the first 4 days.

Delay in the detection of tuberculosis was the main factor contributing to death in our patients.