A Study of Doctor's Delay in Patients with Pulmonary Tuberculosis in a General Hospital Lacking Tubereulosis Ward

We retrospectively evaluated clinical findings and diagnostic process of 79 pulmonary tuberculosis patients diagnosed in Niigata City General Hospital, which has no ward for tuberculosis patients, between 1993 and 2000. 50 patients (63%) were bacilli positive by the sputum examination. 20 patients (25%) were smear-positive and 30 patients (38%) were smear-negative and culture-positive. In other cases the specimens such as gastric juice, bronchial lavage fluid and pleural effusion were utilized for diagnosis. The characteristics of 36 cases diagnosed after admission (Group I) were compared with 43 cases diagnosed at the outpatients department (Group II). The patients in Group I were more elderly and had severer underlying diseases, which were known to affect immunity, than those in Group II. In Group I only 5 cases (14%) were suspected of pulmonary tuberculosis and 16 cases (44%) were suspected of bacterial pneumonia at the initial evaluation. On the other hand 25 cases (58%) of the patients in Group II were initially suspected of pulmonary tuberculosis. Doctor's delay of the patients in Group I was longer than that of those in Group II. Doctor's delay of the patients suspected of pulmonary tuberculosis at the initial evaluation (mean, 29 days) was shorter than that of the patients suspected of other diagnoses (mean, 43 days). In cases with persistent productive cough and fever routine chest roentogenogram is recommended for any patients. The absence of initial suspicion of pulmonary tuberculosis leads to a significant delay in diagnosis. It is utmost important for physicians to suspect tuberculosis for the early diagnosis of the disease