Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark,
International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark,
Respiration. 2019;97(6):576-584. doi: 10.1159/000499052. Epub 2019 Apr 17.
Early detection and treatment of tuberculosis (TB) is essential to achieve the goals appointed in the WHO End TB Strategy. Tuberculous lymphadenitis (TBLA) is the most common manifestation of extrapulmonary TB, but the diagnosis can be challenging in low-incidence countries due to sparse and inconsistent clinical features, resulting in delay. We aimed to summarize and discuss the current literature on patient delay, health care delay, and total delay (i.e., time to first health care contact, diagnosis, and treatment) in patients with TBLA in TB low-incidence countries. A systematic review using PubMed was conducted, searching for studies set in TB low-incidence countries (defined as <20 per 100,000 citizens) that reported on health care seeking behaviour, patient delay, health care delay, and/or total delay. Studies were categorized by type of delay and compared. We identified 11 heterogeneous studies with highly variable observations. Mean patient delay varied from 55 to 154 days (range, 14-1,461), mean health care delay from 44 to 94 days (range, 7-224) and median total delay from 77.5 to 122 days (range, 0-2,820). Evidently, more comprehensive insights into the diagnostic pathway and delay in TBLA patients are warranted.
早期发现和治疗结核病（TB）对于实现世界卫生组织终止结核病战略中的目标至关重要。结核性淋巴结炎（TBLA）是肺外结核病最常见的表现，但在发病率较低的国家，由于临床特征稀少且不一致，诊断具有挑战性，导致延误。我们旨在总结和讨论发病率较低的国家中 TBLA 患者的患者延迟、医疗保健延迟和总延迟（即首次获得医疗保健接触、诊断和治疗的时间）的当前文献。使用 PubMed 进行了系统评价，检索了在结核病发病率较低的国家（定义为每 10 万人<20 人）进行的研究，这些研究报告了医疗保健寻求行为、患者延迟、医疗保健延迟和/或总延迟。研究按延迟类型进行分类并进行比较。我们确定了 11 项具有高度变异性观察结果的异质研究。患者延迟的平均时间从 55 天到 154 天不等（范围为 14-1461 天），医疗保健延迟的平均时间从 44 天到 94 天不等（范围为 7-224 天），总延迟的中位数从 77.5 天到 122 天不等（范围为 0-2820 天）。显然，需要更全面地了解 TBLA 患者的诊断途径和延迟情况。
