Overdiagnosis of Tuberculosis in Patients Referred for Hospitalization to TB Unit

Abstract

The objective: to establish the reasons of discrepancy between the preliminary and final clinical diagnoses in patients admitted to TB inpatient unit, to determine ways to improve the diagnosis of tuberculosis at the pre-hospital stage.Subjects and Methods. We studied 130 medical records of patients (77 HIV negative patients - Group 1, 53 HIV positive patients – Group 2) admitted to the inpatient unit of TB hospital in 2014-2022, in whom tuberculosis (TB) was excluded after examination.Results. In Group 1, all patients were preliminary diagnosed with pulmonary tuberculosis, in Group 2, 29 patients were preliminary diagnosed with pulmonary tuberculosis and 24 patients - with tuberculous meningitis (TM). Primary examination and analysis of medical records caused doubts about the diagnosis of 60 (77.9%) patients in Group 1, and 40 (75.5%) patients in Group 2. When pulmonary tuberculosis was suspected, pneumonia and cancer were most often verified: 33.8% and 27.3% in Group 1, 51.7% and 24.1% in Group 2, the causes of diagnostic errors at the pre-hospital stage included insufficient attention to medical history and clinical manifestations; outcomes of treatment with broad-spectrum antibiotics were ignored; no control radiological examination was performed; diagnostic fibrobronchoscopy, chest computed tomography, consultations of medical specialists were not provided. Often HIV negative individuals 25/47 (53.2%) had false positive results of sputum microscopy. In Group 2, in 24 patients with suspected tuberculous meningitis, the final diagnosis was cerebral toxoplasmosis (41.7%) and mycotic meningitis (25.0%). Poor coverage with neuroimaging, genetic molecular and serological tests led to diagnostic errors.