Prompt diagnosis and treatment improves the likelihood of successful outcome for patients infected with Mycobacterium Tuberculosis. Between 1985 and 1995, 5% of US TB cases were discovered at autopsy. Untreated TB remains contagious, the patient suffers unnecessarily, and may die prematurely.
We fit a regression model for the risk of autopsy diagnosis using the CDC National TB surveillance database, adjusting for patient characteristics.
Of the 267,659 TB cases reported 13,058 were diagnosed at autopsy. High risk of autopsy diagnosis was observed among patients aged 65+ years (aOR range 3.29 to 9.38), non-Hispanic blacks (aOR=1.27), and Hispanics (aOR=1.24). Females and foreign born persons were less likely to be discovered after death. Over the study period, there was sustained decreasing trend in the number of autopsy cases. Most undiagnosed cases were of pulmonary type (82.1%) and most undiagnosed sites were miliary (19.3%), peritoneal (14.6%), and meningeal (13.4). Homeless persons had lower risk compared to non-homeless persons (2.4% vs. 3.7%, aOR=0.77). Long-term-care facility residents had higher risk compared to patients outside LTC facilities (9.7% vs. 3.4%, aOR=1.55).
Even though the rates of undiagnosed TB have been declining in the USA, there is need for more effort to diagnose TB among the elderly, non-Hispanic blacks, non-Hispanic whites, males, American born, and residents of LTC facilities. Miliary, peritoneal, and meningeal sites are most likely to be undiagnosed until death. Screening, diagnosis, and treatment for TB is critical in high risk sub-groups. Further research needs to quantify the relative risk of infection attributable to an undiagnosed dead index case.
Learning Objectives: N/A
Keywords: Tuberculosis, Data/Surveillance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.