Delayed diagnosis of extrapulmonary tuberculosis presenting as fever of unknown origin in an intermediate-burden country

Autor:	Ji Hwan Bang, Myoung Don Oh, Eu Suk Kim, Hyun gul Jung, Hong Bin Kim, Wan Beom Park, Kang Il Jun, Pyeong Gyun Choe, Jeong Han Kim, Kyoung Ho Song, Sang Won Park, Nam Joong Kim
Jazyk:	angličtina
Rok vydání:	2018
Předmět:	Adult Male medicine.medical_specialty Tuberculosis Delayed Diagnosis Adolescent Endemic Diseases 030204 cardiovascular system & hematology Delayed diagnosis lcsh:Infectious and parasitic diseases Diagnosis Differential 03 medical and health sciences Young Adult 0302 clinical medicine Medical microbiology FUO Risk Factors Internal medicine Republic of Korea medicine Blood test Humans lcsh:RC109-216 030212 general & internal medicine Risk factor Fever of unknown origin Tuberculosis Pulmonary Extrapulmonary tuberculosis Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Middle Aged medicine.disease Lung involvement Infectious Diseases Cross-Sectional Studies Imaging study Female business Research Article
Zdroj:	BMC Infectious Diseases, Vol 18, Iss 1, Pp 1-8 (2018) BMC Infectious Diseases
ISSN:	1471-2334
DOI:	10.1186/s12879-018-3349-5
Popis:	Background Tuberculosis (TB), especially extrapulmonary tuberculosis (EPTB), is an important cause of fever of unknown origin (FUO) in TB-burdened areas. Little information is known about patients with EPTB with clinical features presenting as FUO and about the factor of delaying the diagnosis. Methods We retrospectively analyzed EPTB patients who were referred with FUO at 3 university-affiliated hospitals over 8 years (2010–2017). The subjects were assigned to groups of early diagnosis and delayed diagnosis within 3 days of an initial comprehensive evaluation from the referral. Clinical and laboratory variables were compared between the groups. Results A total of 95 patients with febrile EPTB were included. Localizing symptoms and/or signs suggestive of anatomy were identified in 62.1% of the patients. Concurrent lung involvement by TB was presented by 49.5% (47/95) of the patients, and only 23.4% of them showed typical findings of pulmonary TB on simple chest X-ray. Most of the patients showed abnormal lesions on cross-sectional CT (98.9%) and MRI (100%). The clinical variables and blood test results of patients were not significantly different between the two groups. The less typical imaging finding of EPTB on CT (38.5% vs. 79.0%) and MRI (37.5% vs. 79.0%) in the delayed diagnosis group was a risk factor for delayed diagnosis. Conclusion Febrile EPTB referred as FUO showed nonspecific clinical manifestations. The active application of cross-sectional imaging tests according to clinical clues or randomly in the absence of local manifestations, combined with invasive diagnostic approaches even for atypical presentations may lead to an earlier diagnosis of febrile EPTB.
Databáze:	OpenAIRE
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