Extreme diagnostic delay of pulmonary tuberculosis in a high-risk patient: implications for public health
1
1 Vale do Sousa Sul Public Health Unit, Tâmega e Sousa Local Health Unit, Paredes, Portugal
2
2 Institute of Public Health, University of Porto, Porto, Portugal
Popul. Med. 2026;8(Supplement Supplement 1):A603
ABSTRACT
INTRODUCTION:
Pulmonary tuberculosis (PTB) remains a major global public health challenge, and early diagnosis is essential to reduce morbidity, mortality, and community transmission 1, 2. Despite established tuberculosis control strategies, diagnostic delay persists and represents a critical failure point in tuberculosis prevention and control, even among individuals with well-recognized risk factors 3.
METHODS:
We report a case of extreme diagnostic delay of PTB based on a retrospective review of clinical records, imaging findings, and microbiological data. The patient’s healthcare trajectory across multiple levels of care was analyzed to identify contributing factors to delayed diagnosis and associated public health implications.
RESULTS:
A 57-year-old male construction worker with silicosis and previously treated latent tuberculosis infection developed persistent cough, dyspnea, fever, night sweats, weight loss, and progressive functional decline beginning in October 2024. Over a period of 272 days, he had repeated contacts with healthcare services, including emergency departments, primary care, and hospital outpatient clinics. Symptoms were repeatedly attributed to respiratory infections or exacerbation of chronic lung disease, resulting in multiple courses of antibiotics and systemic corticosteroids without early microbiological testing. Radiological abnormalities were interpreted as related to pre-existing lung disease. Pulmonary tuberculosis was only diagnosed after sustained clinical deterioration, when sputum examination revealed acid-fast bacilli and cavitary disease. The prolonged infectious period required extensive contact tracing, indicating a substantial public health burden 1, 2.
CONCLUSIONS:
This case highlights how pulmonary tuberculosis may remain unrecognized even in individuals with multiple risk factors, leading to prolonged infectiousness and preventable community exposure. Diagnostic anchoring to chronic lung disease and prior treatment for latent tuberculosis may reduce clinical suspicion, despite being established risk factors for reactivation 4, 5. Systematic exclusion of tuberculosis in patients with persistent respiratory symptoms is essential to strengthen tuberculosis control and protect public health 3, 6.
Pulmonary tuberculosis (PTB) remains a major global public health challenge, and early diagnosis is essential to reduce morbidity, mortality, and community transmission 1, 2. Despite established tuberculosis control strategies, diagnostic delay persists and represents a critical failure point in tuberculosis prevention and control, even among individuals with well-recognized risk factors 3.
METHODS:
We report a case of extreme diagnostic delay of PTB based on a retrospective review of clinical records, imaging findings, and microbiological data. The patient’s healthcare trajectory across multiple levels of care was analyzed to identify contributing factors to delayed diagnosis and associated public health implications.
RESULTS:
A 57-year-old male construction worker with silicosis and previously treated latent tuberculosis infection developed persistent cough, dyspnea, fever, night sweats, weight loss, and progressive functional decline beginning in October 2024. Over a period of 272 days, he had repeated contacts with healthcare services, including emergency departments, primary care, and hospital outpatient clinics. Symptoms were repeatedly attributed to respiratory infections or exacerbation of chronic lung disease, resulting in multiple courses of antibiotics and systemic corticosteroids without early microbiological testing. Radiological abnormalities were interpreted as related to pre-existing lung disease. Pulmonary tuberculosis was only diagnosed after sustained clinical deterioration, when sputum examination revealed acid-fast bacilli and cavitary disease. The prolonged infectious period required extensive contact tracing, indicating a substantial public health burden 1, 2.
CONCLUSIONS:
This case highlights how pulmonary tuberculosis may remain unrecognized even in individuals with multiple risk factors, leading to prolonged infectiousness and preventable community exposure. Diagnostic anchoring to chronic lung disease and prior treatment for latent tuberculosis may reduce clinical suspicion, despite being established risk factors for reactivation 4, 5. Systematic exclusion of tuberculosis in patients with persistent respiratory symptoms is essential to strengthen tuberculosis control and protect public health 3, 6.
| eISSN: | 2654-1459 |
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