ANALYSIS OF DELAYED DIAGNOSIS OF TUBERCUL OSIS

OBJECTIVE: To identify the situations that influence in the delayed di agnosis of tuberculosis. PATIENTS AND METHOD: We studied 109 patients (87 non HIV-infected and 22 HIV-infected) who were diagnosed of tuberc ulosis in one year consecutively, using a questionnaire to obtain time intervals in which the whole diagnostic delay (WD) was divided. RESUL TS: WD was higher than 1 month in 90% of non HIV-infected patients. Th e delay due to the health system (SD) was higher (71% > 1 month) than the delay due to patient (PD; 30% > 1 month) and there was a negative correlation between both (R-0.73). In HIV+ group, WD was lower (59.1% > month) and, although PD was higher (40.9% > 1 month), the time that the system delayed the suspicion of the diagnosis was lower (5.5% > 1 month). In HIV-group there were the following significant differences: higher delay in the suspicion of diagnosis (DSD) (61.4% and 60.8% > 1 month) and shorter time to make the diagnosis (12.3% and 21.6% > 1 mo nth) in sputum smear-positive patients and who had cavitary lesions; P D was higher (67.1% > 1 month) in patients with general symptoms and n early none in patients with upper airways symptoms; and higher DSD in presence of nonspecific symptoms like cough or/and expectoration (68.6 % > 1 month) or upper airways symptoms (100% > 1 month). As these clin ical symptoms were consulted in primary care mainly, there was a highe r SD (75.7% > 1 month) and DSD (58.1% > 1 month), and were increased w hen a promptly chest X-ray was not performed (87.1 and 68.7% > 1 month ). CONCLUSIONS: Delayed diagnosis of tuberculosis is common. In non HI V-infected patients, it occurs mainly in the health system. Diagnostic delays contribute to raise advanced disease with more contagious pote ntial.