Challenges in Pulmonary Tuberculosis Diagnosis: Identifying Alternate Conditions in Clinically Diagnosed Patients

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

RATIONALE: In regions with a high burden of tuberculosis, such as Pakistan, where over half ofpulmonary tuberculosis (PTB) cases are diagnosed through clinical assessments or show negativeresults on smear tests, accurately identifying TB remains a significant challenge even with theavailability of rapid confirmatory tests. This retrospective cross-sectional study conducted at atertiary care hospital in Karachi, Pakistan aimed to explore the reasons behind the high rate ofclinically diagnosed PTB and to investigate potential alternate diagnoses that mimic PTB.METHODS:A retrospective cross-sectional study was conducted at a tertiary care hospital inKarachi, Pakistan. Clinically diagnosed PTB patients were selected, and their response to anti-tuberculosis treatment (ATT) was observed through subsequent clinical visits and chart reviews.Patients showing a lack of response to ATT underwent further diagnostic workup, and alternatediagnoses were recorded. RESULTS:Out of 61 patients clinically diagnosed with PTB, 55%demonstrated clinical and radiological improvement with ATT, while 45% did not respond totreatment. Among those who failed to improve, alternate diagnoses were established, revealingmetastatic disease (n=10), lung malignancy (n=8), chronic heart failure (n=3), post TBbronchiectasis (n=2), allergic bronchopulmonary aspergillosis (ABPA) (n=1), and chronic pulmonaryaspergillosis (CPA) (n=1). CONCLUSIONS:This study underscores the substantial proportion ofclinically diagnosed PTB patients who failed to respond to ATT and were subsequently diagnosedwith alternative conditions. The use of ATT in these cases not only delayed appropriate treatmentfor the primary disease but also exposed patients to potentially harmful medications. The findingsemphasize the necessity for a comprehensive review of clinically diagnosed PTB cases to consideralternate diagnoses before initiating ATT. Failure to identify alternative conditions can lead todelayed and inadequate treatment, compromising patient outcomes. This study highlights theimportance of accurate differential diagnosis in PTB cases to optimize patient care and treatmentstrategies.

Volume

209

Issue

Suppl

First Page

A2338

Comments

International Conference of the American Thoracic Society, May 17-22, 2024, San Diego, CA

DOI

10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A2338

Link to Full Text

Share

COinS