| Popis: |
Background: In Pakistan more than 52% of Pulmonary tuberculosis (PTB) cases diagnosed are smear negative/ clinically diagnosed TB. This rate is very high in the era of more reliable and rapid tests available for the confirmation of TB. The reasons for the high proportion of clinically diagnosed TB are not clear. While the diagnosis of PTB is usually straightforward, several disorders can be mistaken for it. Common misdiagnoses of smear negative PTB include post TB bronchiectasis, malignancy, allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA) Methods: A retrospective cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. Clinically diagnosed PTB patients were selected and their response to treatment was reviewed in subsequent clinical visits through review of charts. Any alternate diagnosis that would emerge in this time was recorded Results: Out of the 61 patients 33 (55%)showed clinical and radiological improvement with ATT but 28 (45%) failed to improve and were later on found to have alternate diagnosis. Among these 10 had metastatic disease, 8 had lung malignancy, chronic heart failure in 3, post TB bronchiectasis in 2, ABPA in 1 and CPA in 1 patient Conclusion: Although the sample size is small but around half of the patients has failed to respond to therapy and were found to have an alternate diagnosis. Use of ATT in such patients not only delays treatment for their primary disease but also expose patients to potentially toxic medications.There is a need of review the cases of clinically diagnosed TB for an alternate diagnosis before starting ATT |
