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2012

2012 June - Clinical Characteristics of Patients Newly Diagnosed with Tuberculosis in an Acute General Hospital in Hong Kong

Dr. Yu-Hon MAN; Department of Medicine and Geriatrics, Tai Po Hospital

Background: Studies on initial presentation of newly diagnosed patients in hospital were scarce and not most up-to-date. The ageing population and the emergence of new diagnostic tools may have changed the clinical picture.

Objectives: 1) To describe the clinical characteristics of patients newly diagnosed with pulmonary tuberculosis (including TB effusion) in a regional acute hospital in Hong Kong; 2) to present differences in clinical presentation of patients who were or were not diagnosed in the same admission

Method: Newly diagnosed TB patients from January 2007 to December 2009 in the Department of Medicine, Alice Ho Miu Ling Nethersole Hospital were retrospectively reviewed. Clinical characteristics of patients diagnosed and not diagnosed in the same admission were compared. Results: 172 and 41 patients were diagnosed with pulmonary tuberculosis and tuberculous effusion respectively. For pulmonary tuberculosis, 59% were diagnosed in the same admission. Sputum acid fast bacilli (AFB) smear was the commonest method of diagnosis. Nucleic acid amplification test accounted for 9.3% of the cases. For tuberculous effusion, pleural biopsy histology was the most common diagnostic method. The sensitivity of pleural fluid adenosine deaminase was 78%. Patients not diagnosed with pulmonary tuberculosis in the same admission were older (P=0.001), more likely to be AFB smear negative (P<0.001), had single lung involvement (P=0.007), had no cavities on X-ray (P=0.018), stayed longer in hospital (P=0.001) and died (P=0.037).

Conclusion: Almost half of the patients admitted were not diagnosed in the same hospital admission, which was associated with high inpatient mortality.

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