Restrictive treatment policy for pulmonary tuberculosis in a low prevalence country

In Denmark, treatment of tuberculosis is generally recommended only if the diagnosis is confirmed bacteriologically. This policy may cause a delay in treatment, if the patients are smear negative. We investigated the duration of the treatment delay, and whether the delay would cause any serious health problems for the individual, or risk of contact infections, in a retrospective examination of 324 cases of pulmonary tuberculosis. The mean treatment delay was longer in the oldest age group. Concerning death due to delay, we found no risk for those patients who were not weakened by other disease or old age. Only 11 patients (3.6%) over the age 10 yrs were treated without bacteriological confirmation (1% for Danes). The infection risk from the smear negative but culture positive patients was minimal, as only one subject was definitely infected from a smear negative patient. However, a risk of transmission exists from patients who are initially culture negative but later become smear positive. In conclusion, we find the epidemiological and individual risks sufficiently low to continue our rather restrictive treatment policy.