WHY DO OUR PATIENTS DIE OF ACTIVE TUBERCULOSIS IN THE ERA OF EFFECTIVE THERAPY

Setting: All patients with tuberculosis as a primary or underlying cau se of death who were autopsied at the Institute for Lung Diseases and Tuberculosis, Sremska Kamenica, in the former Yugoslavia, between 1981 and 1990 were investigated. Objective: To study why people die of act ive tuberculosis in the era of effective chemotherapy and to identify factors contributing to death. Design: In a retrospective investigatio n, this index group was compared with a control group consisting of pa tients who suffered from tuberculosis over the same period but who imp roved and were discharged from hospital. Results: A significant differ ence in age (P < 0.05) was found between those patients who died with an antemortem-established diagnosis and those who died with unrecognis ed tuberculosis (median 49 and 60 years respectively). When it came to the index group, 28 patients (56%) had one or more risk factors and t he frequency of alcohol abuse was significantly higher (P < 0.001). An tituberculosis treatment had been introduced in 27 cases (54%). The me dian duration of hospitalization before therapy was 2 days and the med ian duration of antituberculosis therapy was 7 days. Of the 23 untreat ed tuberculosis patients, 74% died within the first 4 days. Conclusion : Delay in the detection of tuberculosis was the main factor contribut ing to death in our patients.