TUBERCULOSIS IN THE AUTOPSY MATERIAL - ANALYSIS OF 1500 AUTOPSIES PERFORMED BETWEEN 1972 AND 1991 IN THE INSTITUTE OF TUBERCULOSIS AND CHEST DISEASES, WARSAW, POLAND

Setting: The present study is based on 1500 autopies done in the Insti tute of Tuberculosis and Chest Diseases Warsaw, Poland during the year s 1972-81 and 1982-91. Objective: To assess the correctness of tubercu losis diagnosis before death in the above mentioned time periods. Desi gn: The autopsy reports were examined for the diagnosis of active tube rculosis proved by microscopy. The form and localisation of tuberculos is was assessed. The postmortem diagnosis was compared with clinical d iagnosis. In those cases in which tuberculosis was not recognised befo re death the possible causes of this failure were analyzed. Results: A ctive tuberculosis was found in 119 cases, 7.9% of all autopsies. It w as localised in the lungs exclusively in 72 cases, in lungs and in ext rapulmonary sites in 45 and in extrapulmonary sites only in 2. The fre quency of active tuberculosis was the same for the two periods under e valuation. Tuberculosis was however not recognised before death in a m uch higher proportion of cases in 1982-91 (54%) than in 1972-81 (24%). The main cause of diagnostic failure was connected with atypical loca lisation of lesions on chest X-ray and with dissemination outside the lungs. Previous tuberculosis was a factor which facilitated the diagno sis of tuberculosis. Conclusion: In parallel with the decline of tuber culosis incidence in Poland, many doctors lack experience in diagnosin g this disease, especially in cases with atypical X-ray presentation a nd with extrapulmonary localisation. This may lead to late or even ver y late diagnosis and have a significant impact on the epidemiological situation.