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ARTICLE |

The Impact of Respiratory Failure on the Diagnosis of Tuberculosis

John E. Heffner, MD; Charlie Strange, MD; Steven A. Sahn, MD
Arch Intern Med. 1988;148(5):1103-1108. doi:10.1001/archinte.1988.00380050107017.
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• Six patients with hypoxic respiratory failure (arterial Po2/alveolar Po2<0.50) resulting from active tuberculosis were evaluated to assess the impact of respiratory failure on the diagnosis of the underlying tuberculosis. All patients demonstrated anemia (hematocrit [mean±SEM], 0.29±0.01 [29.0% ±1.0%]) and hypoalbuminemia (serum albumin, 22±2 g/L [2.2±0.2 g/dL]) and noted an illness longer than one week. Findings on chest roentgenograms varied from a miliary pattern, misinterpreted as congestive heart failure, to cavitary and noncavitary alveolar infiltrates, misdiagnosed as bacterial pneumonia. Tuberculosis was not considered as a diagnostic possibility on admission in any patient. The mean time from admission until consideration of tuberculosis was 4.7±1.0 days and the time to diagnosis was 7.2 ±1.7 days. In contrast, tuberculosis was considered on admission In 12 patients presenting with undiagnosed active tuberculosis without respiratory failure. We conclude that respiratory failure delays the diagnosis of active tuberculosis by suggesting nontuberculous pneumonia.

(Arch Intern Med 1988;148:1103-1108)

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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