PDF(Pubmed)
Abstract：
Disseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis.
To describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period.
We consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings.
We included all 30 patients reported during the study period-5, 9, and 16 in 2019, 2020, and 2021 respectively-20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8-30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p < 0.001).
There was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic.
To describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period.
We consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings.
We included all 30 patients reported during the study period-5, 9, and 16 in 2019, 2020, and 2021 respectively-20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8-30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p < 0.001).
There was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic.
摘要：
■播散性结核病通常与诊断延迟和预后较差有关。
■描述COVID-19期间低结核病负担国家的传播结核病病例系列和诊断延迟。
■我们连续纳入了2019年至2021年在巴塞罗那都会区北冠参考医院报告的所有播散性结核病患者。我们收集了社会人口统计信息，临床,实验室和放射学发现。
■我们纳入了研究期间报告的所有30例患者，分别为2019年、2020年和2021年的5例、9例和16例，其中20例（66.7％）为男性，平均年龄为41岁。25（83.3％）是非欧盟血统。最常见的系统受累是中枢神经系统（N=8；26.7%），其次是内脏系统（N=7；23.3%），胃肠道（N=6，20.0%），肌肉骨骼（N=5；16.7%），和肺（N=4；13.3％）。低蛋白血症和贫血非常普遍（72％和77％）。诊断延迟的中位数为6.5个月（IQR1.8-30），女性中的比例更高(36.0vs.3.5个月；p=0.002）。中枢神经系统受累和肺部受累与女性的诊断延迟有关。我们记录了24名治愈的病人,两人死亡,三名患者治疗后后遗症，还有一个失踪者.我们观察到低收入社区患者的聚集效应(p<0.001)。
■在我们的研究区域中，播散性结核病的诊断有很大的延迟，这可能会影响预后，女性受到的影响更大。我们的结果表明，由于诊断延迟而引起的播散性结核病的发生率增加可能是COVID-19大流行的次要影响。
■描述COVID-19期间低结核病负担国家的传播结核病病例系列和诊断延迟。
■我们连续纳入了2019年至2021年在巴塞罗那都会区北冠参考医院报告的所有播散性结核病患者。我们收集了社会人口统计信息，临床,实验室和放射学发现。
■我们纳入了研究期间报告的所有30例患者，分别为2019年、2020年和2021年的5例、9例和16例，其中20例（66.7％）为男性，平均年龄为41岁。25（83.3％）是非欧盟血统。最常见的系统受累是中枢神经系统（N=8；26.7%），其次是内脏系统（N=7；23.3%），胃肠道（N=6，20.0%），肌肉骨骼（N=5；16.7%），和肺（N=4；13.3％）。低蛋白血症和贫血非常普遍（72％和77％）。诊断延迟的中位数为6.5个月（IQR1.8-30），女性中的比例更高(36.0vs.3.5个月；p=0.002）。中枢神经系统受累和肺部受累与女性的诊断延迟有关。我们记录了24名治愈的病人,两人死亡,三名患者治疗后后遗症，还有一个失踪者.我们观察到低收入社区患者的聚集效应(p<0.001)。
■在我们的研究区域中，播散性结核病的诊断有很大的延迟，这可能会影响预后，女性受到的影响更大。我们的结果表明，由于诊断延迟而引起的播散性结核病的发生率增加可能是COVID-19大流行的次要影响。
