Disseminated tuberculosis and diagnosis delay during the COVID-19 era in a Western European country: a case series analysis

Frontiers in Public Health

Public Health

Elsa Plasencia¹  Cristina Vilaplana²  Tania Baena³  Carmen Bracke⁴  Cora Loste⁴  Nieves Sopena⁴  Esteban A. Reynaga⁴  Rosa Maria Benítez⁴  Lourdes Mateu⁴  Bonaventura Clotet⁴  Maria Lluïsa Pedro-Botet⁵  Judith Llussà⁶  Germán Portela⁶  Adrián Antuori⁶  Clara Flamarich⁶  Ricard Pérez⁷  Jordi Bechini⁸  Montserrat Tenesa⁸  Laura Soldevila⁹  Sílvia Roure^1,10  Xavier Vallès^1,11 

[1] Departament de Salut, Subdirecció General de Vigilancia i Resposta a Emergències de Salut Pública, Barcelona, Catalonia, Spain;Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain;Germans Trias i Pujol Research Institute, Badalona, Spain;Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain;Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain;Unitat de Tuberculosi Experimental, Microbiology Department, Germans Trias i Pujol, Badalona, Spain;Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain;Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain;Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain;Servicio de Enfermedades Infecciosas, Hospital Universitari Germans Trias i Pujol, Badalona, Spain;Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain;Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain;Microbiology Department, Northern Metropolitan Clinical Laboratory, Hospital Germans Trias i Pujol, Badalona, Spain;Servei de Radiodiagnòstic de l’Hospital Universitari Germans Trias i Pujol, Badalona, Spain;Servei de Radiodiagnòstic de l’Hospital Universitari Germans Trias i Pujol, Badalona, Spain;Direcció Clínica de Diagnòstic per la imatge de la Gerència Territorial Metropolitana Nord, Badalona, Spain;Unitat de Salut Internacional Metropolitana Nord, PROSICS Metropolitana Nord, Badalona, Spain;Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain;Unitat de Salut Internacional Metropolitana Nord, PROSICS Metropolitana Nord, Badalona, Spain;Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain;Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain;Unitat de Salut Internacional Metropolitana Nord, PROSICS Metropolitana Nord, Badalona, Spain;Direcció Clínica Territorial de Malalties Infeccioses i Salut Internacional de Gerència Territorial Metropolitana Nord, Barcelona, Spain;Fundació Lluita Contra les Infeccions, Hospital Germans Trias i Pujol, Badalona, Spain;Germans Trias i Pujol Research Institute, Badalona, Spain;

关键词: disseminated tuberculosis;    tuberculosis;    delayed diagnosis;    hard-to-reach populations;    clinical presentation;   

DOI  :  10.3389/fpubh.2023.1175482

 received in 2023-02-27, accepted in 2023-04-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundDisseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis.ObjectivesTo describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period.MethodologyWe 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.ResultsWe 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).ConclusionThere 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.

【 授权许可】

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Copyright © 2023 Roure, Vallès, Sopena, Benítez, Reynaga, Bracke, Loste, Mateu, Antuori, Baena, Portela, Llussà, Flamarich, Soldevila, Tenesa, Pérez, Plasencia, Bechini, Pedro-Botet, Clotet and Vilaplana.