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Pulmonary tuberculosis in intern’s practice: errors in diagnosis


Author: Ion Nikolenko
Degree:doctor of medicine
Speciality: 14.00.26 - Phtisiopneumology
Year:2007
Scientific adviser: Sergiu Matcovschi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Aurelia Ustian
doctor, associate professor (docent)
Institution:
Scientific council:

Status

The thesis was presented on the 7 February, 2007
Approved by NCAA on the 19 April, 2007

Abstract

Adobe PDF document0.27 Mb / in romanian

Keywords

tuberculosis, lung tuberculosis, diagnostic mistakes, internal medicine practice, general hospital, hospitals not specialized in treatment of the tuberculosis

Summary

There were 936 patients involved in this study, 706 sick people, at which in the period from 2001 to 2005, in various hospitals of general profile, non specialized was suspected the TB infection, these people were sent to the Clinical Hospital of Phtysiology were the diagnosis has been confirmed in 422 patients; 101 sick with pulmonary tuberculosis were admitted in the Clinical Hospital of Phtysiology sent by doctors from the primary institutions which are concerned about the necessary medical assistance, who have detected the disease; 129 sick with common tuberculosis.

The results of the investigations have proved, that pulmonary tuberculosis is observed and actually confirmed in the Institutions of Phtysiology at 0, 7% from patients admitted in the general therapy section and at 0, 4% of patients referred to the sections of therapeutic profile of somatic hospitals. Only 68, 3% of sick people from large profile hospitals, sent at the above mentioned institutions for confirming the TB diagnosis and then the treatment follows. The fate of the rest 31,7% of patients remains to be unknown. TB disease is confirmed in the above mentioned Institutions only 59,8% of patients who are thought to be sick with this disease. Hiperdiagnosis of TB disease in the somatic hospitals is of 40,2%. The forms of TB disease at the admitted patients in the general profile are: infiltrative (61,8%), disseminated (14,2%), fiber-cavitary (11,8%) and TB pleurisy (12,1%).

At 44,3% of patients the disease develops with one or more concomitants disease. The over nutrition of the population is a very important factor which determines the incidence as well as mortality of people sick with TB disease.

The errors made in the diagnosis of the disease are: late arrival of sick people at the specialists of this field, carelessness of doctors concerning this malady, insufficiency considering anamnesis data and TB symptomatic, the frequent pseudo pneumonic evolution of the disease, masked TB diseases by other associated diseases, the lack of radiological examination and the sputum analysis Koch’s bacillus.

The death causes of the patients sick with pulmonary TB disease admitted in the hospitals of general profile are: late arrival to the doctor of the above mentioned patients, in the late stage of the disease; misdiagnosis of the disease in pre hospital level and patient admition in somatic hospitals, non specialized in phtysiology.