Undiagnosed tuberculosis as the reason of failure in treatment of critical care patients

Intensive treatment sometimes becomes unsuccessful due to diagnostics mistakes. Tuberculosis — one of the most serious diseases in Russia — also leads to critical status of patients. But in some of such patients tuberculosis remains undiagnosed. Purpose of present study was to analyse why not recognition of pulmonary tuberculosis became the reason of failure in treatment of critical care patients. Thirty-eight cases of patients (28 men and 10 women) treated in emergency departments of general practice hospitals of Tatarstan Republic, Russia, were investigated. Age of patients was from 42 to 77 years. Clinical diagnosis of pneumonia was in 86.8% of them, pleuritis of obscure etiology in 10.5% and one patient had clottage of mesenteric blood vessels. Patients status at entering the hospitals was estimated as serious. Complaints to tussis with a sputum were in 89.5% cases. Average value of ESR was 17.3 mm/h, leukocytosis -16.2 × 10⁹/l. All patients received a complex intensive care. Patient with the surgical pathology was operated. But despite treatment there were not improvement in patients status, and 1–5 days after entering hospitals all patients died. Postmortem examination found out that the reason of failure in complex treatment of patients was undiagnosed pulmonary tuberculosis. Infiltration tuberculosis was in 14 patients, fibro-cavernous in 13 patients and disseminated tuberculosis in 11 patients. Analysis of that cases showed that radiography was done only to 36.8% of patients on the average 2.3 days after entering the hospitals. Sputum microscopy was done only in two cases and also with an appreciable delay. In both cases BK were found out. Radiography and smear microscopy results became accessible to doctors only after patients morses. Investigation showed the necessity of urgent fulfillment of radiography and sputum microscopy in critical patients with suspicion of pulmonary tuberculosis just after entering the hospitals.