The Untimely Misfortune of Tuberculosis Diagnosis at Death

Abstract

Introduction: Most of the burden of tuberculosis (TB) in the United States resides in underserved minorities in the inner city. Prompt diagnosis and initiation of therapy are crucial. Methods: We performed a retrospective review for a 12-year period of a major inner city hospital in the United States to identify cases of TB diagnosed at the time of death or postmortem. Results: We identified 35 cases for a 12-year period. Of these, 33 (94%) were culture-confirmed cases of TB. At the time of autopsy, 6 cases (17%) were identified. In all these cases, there was no clinical suspicion of TB. Pulmonary TB was confirmed in 27 (77%) of the 35 patients, whereas 8 (23%) of the 35 had extrapulmonary TB. Of those with extrapulmonary TB, 6 patients had disseminated TB; 1, peritoneal TB; and 1, meningeal TB. Discussion: Clinicians serving underserved populations with high human immunodeficiency virus infection/ acquired immune deficiency syndrome prevalence or other comorbidities such as diabetes and/or with currently high TB prevalence rates and high clinical suspicion of acute disseminated forms of TB even without bacteriologic confirmation, a therapeutic trial of antituberculous drugs should be entertained among those patients in whom there is strong clinical suspicion.