Delays in diagnosis and treatment of extrapulmonary tuberculosis in Guatemala.
Pooja Ajay ShahMerida CojPeter RohloffPublished in: BMJ case reports (2017)
A 23-year-old indigenous Guatemalan man presented in 2016 to our clinic in Sololá, Guatemala, with 10 months of recurrent neck swelling, fevers, night sweats and weight loss. Previously, he had sought care in three different medical settings, including a private physician-run clinic, a tertiary private cancer treatment centre and, finally, a rural government health post. With assistance from our institution's accompaniment staff, the patient was admitted to a public tertiary care hospital for work-up. Rifampin-susceptible tuberculosis was diagnosed, and appropriate treatment was begun. The case illustrates how low tuberculosis recognition among community health workers and health system segmentation creates obstacles to appropriate care, especially for patients with limited means. As a result, significant diagnostic and treatment delays can occur, increasing the public health burden of tuberculosis.
Keyphrases
- healthcare
- public health
- mycobacterium tuberculosis
- pulmonary tuberculosis
- primary care
- weight loss
- tertiary care
- adverse drug
- hiv aids
- palliative care
- bariatric surgery
- mental health
- emergency department
- health insurance
- south africa
- quality improvement
- case report
- type diabetes
- risk assessment
- roux en y gastric bypass
- gastric bypass
- affordable care act
- long term care
- smoking cessation
- obese patients