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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 189-191

Change of diagnosis of tuberculosis after starting antituberculosis medication: An observation and expected rate of missed diagnosis in a Thailand–Myanmar border district


1 TWS Medical Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. D. Y. Patil University, Pune, Maharashtra, India

Date of Submission09-Jul-2019
Date of Decision10-Aug-2019
Date of Acceptance21-Aug-2019
Date of Web Publication10-Sep-2019

Correspondence Address:
Dr. Pathum Sookaromdee
TWS Medical Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_91_19

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  Abstract 


Background: Tuberculosis is still a big problem in several areas including Indochina. The international border area between countries in this area has a high incidence of tuberculosis. There is a need for good surveillance and management for this specific location in Indochina. Methods: The authors reappraise on the available record on tuberculosis case in a Thai border district to Myanmar. The expected missed diagnosis rate of tuberculosis based on the change of diagnosis after starting antituberculosis medication is calculated. Results: The expected range of change of diagnosis of tuberculosis after starting antituberculosis medication is between 4.0% and 64.1%. Conclusion: The missed diagnosis of tuberculosis in this border area can be expected, and this might be a factor leading to incorrect epidemiological data of tuberculosis in this endemic area.

Keywords: Border, change, diagnosis, missed, tuberculosis


How to cite this article:
Sookaromdee P, Wiwanitkit V. Change of diagnosis of tuberculosis after starting antituberculosis medication: An observation and expected rate of missed diagnosis in a Thailand–Myanmar border district. Biomed Biotechnol Res J 2019;3:189-91

How to cite this URL:
Sookaromdee P, Wiwanitkit V. Change of diagnosis of tuberculosis after starting antituberculosis medication: An observation and expected rate of missed diagnosis in a Thailand–Myanmar border district. Biomed Biotechnol Res J [serial online] 2019 [cited 2019 Sep 23];3:189-91. Available from: http://www.bmbtrj.org/text.asp?2019/3/3/189/266572




  Introduction Top


Tuberculosis is presently seen in developing areas around the word. The disease is highly endemic in the area with poor health infrastructure. The management of tuberculosis requires good case detection and management. In tropical Indochina, tuberculosis is still an important local problem. There are many new reported tuberculosis cases in each year.[1] Furthermore, the emerging drug-resistant tuberculosis becomes the big problem in this area. At present, WHO declares that countries in Indochina are the hot foci of tuberculosis.[2]

At present, the remote area in Indochina is well known for the infectious diseases. The border area is usually a remote area with many health problems. Extremely high prevalence of tuberculosis can be seen at the border area between Thailand and Myanmar.[3] There are several attempts to manage the situation at this area. The use of the active case search and strict control of tuberculosis treatment are the hope for improving the present situation. Nevertheless, there is still a requirement for continuous quality improvement of the program.

In the present report, the authors perform a reappraisal on the local data regarding tuberculosis treatment in a local Thai border district to Myanmar. It can show that there is still a problem of missed diagnosis resulting in change of diagnosis of tuberculosis after starting of tuberculosis medication.


  Methods Top


This study is a clinical mathematical modeling study based on available record on tuberculosis case in a Thai border district to Myanmar. This study is not a study on human, animal, or clinical specimens and requires no ethical approval or written consent form. The primary focus is a Thai border district to Myanmar, namely Suan Phueng district, Ratchaburi province [Figure 1]. The area is a remote district about 220 km from Bangkok, capital of Thailand. In the setting, the active tuberculosis searching by the local hospital was done. The diagnosis of tuberculosis was performed by routine sputum acid fast bacilli (AFB) and chest X-ray for any patients with unexplained chronic cough and weight loss. Each patient with clinical diagnosis of tuberculosis is treated by standard antituberculosis treatment.
Figure 1: The map showing the studied area, Suan Phueng district, Ratchaburi province, Thailand

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The local record regarding tuberculosis situation in this district during the first trimester of year 2018 was analyzed in the present study. The descriptive statistical analysis was used for calculation for the rate of change of diagnosis of tuberculosis after starting antituberculosis medication. Then, the expected range was estimated based on 95% confidence interval calculation.


  Results Top


According to this study, there are 6 registered new cases of tuberculosis in the study setting. Of these cases, there is 1 case with change of diagnosis of tuberculosis after starting antituberculosis medication giving the rate equal to 16.67%. The change of diagnosis is due to the final microbiological and molecular confirmation test. The expected range of change of diagnosis of tuberculosis after starting antituberculosis medication is between 4.0% and 64.1%.


  Discussion Top


Tuberculosis is an important disease in Indochina. The disease is still common and widely affects local people in this area. Although there is an attempt to control the disease for a long time, it is still not successful for disease control in this area. The emerging of drug-resistant tuberculosis problem leads to the increase in attempts to manage the disease.[4] At present, the disease surveillance is regularly done with hope for successful early case detection and management.

In Thailand, a local country in Indochina, tuberculosis is still a present national public health problem. In management of tuberculosis patients, the medication is the standard treatment. The close follow-up during treatment is required. However, there are still some problems relating to antituberculosis treatment. The loss of follow-up among the local patients is not uncommon. Some patients might not receive complete treatment.[5]

There are some missed follow-up cases and deaths. Regarding missed follow-up case, further problem can be expected. The induction of drug resistance problem is possible. The drug resistance is also detectable in this area. The incomplete treatment can result in drug resistance, and this problem is common and observable in a tuberculosis patient with previous history of treatment in Indochina.[6] The poor knowledge of the local people is detected in this area and might relate to difficulty in tuberculosis management.[7],[8]

Nevertheless, there is also a little mentioned problem – the change of diagnosis after starting antituberculosis treatment. Indeed, in general practice, the tuberculosis is usually based on clinical diagnosis. The positive sputum AFB and chest X-ray finding is usually used as a presumptive diagnosis. In the present study, all diagnosed cases are first based on this general practice. Nevertheless, the final microbiological and molecular confirmation tests are used as confirmation for verifying the final diagnosis. Of interest, the verification can show that there is a possibility of incorrect first diagnosis of tuberculosis. The patient with missed diagnosis already received antituberculosis drug. This can show that the medical error in diagnosis of tuberculosis is not uncommon in this setting.

In fact, the clinical diagnosis of tuberculosis by simple classical approach might result in false negative. The study in Thailand showed that the molecular diagnosis can help increase case detection.[9] However, it is little mentioned about the false positive from classical approach. Indeed, the problem of overdiagnosis of endemic infectious disease in Thailand is reported in the literature such as in dengue cases.[10] There is a need to improve the diagnostic system. In addition, the local practitioner has to get continuous medical education to improve the proficiency in medical practice.


  Conclusion Top


The missed diagnosis of tuberculosis exists in the study setting. The missed diagnosis reflects the poor quality in tuberculosis diagnosis and case search in this area which might further result in incorrect epidemiology data. There is a requirement for improvement of the tuberculosis surveillance and management system in this area.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khan MK, Islam MN, Ferdous J, Alam MM. An overview on epidemiology of tuberculosis. Mymensingh Med J 2019;28:259-66.  Back to cited text no. 1
    
2.
Minetti A, Camelique O, Hsa Thaw K, Thi S, Swaddiwudhipong W, Hewison C, et al. Tuberculosis treatment in a refugee and migrant population: 20 years of experience on the Thai-Burmese border. Int J Tuberc Lung Dis 2010;14:1589-95.  Back to cited text no. 2
    
3.
Wise J. WHO identifies 16 countries struggling to control tuberculosis. BMJ 1998;316:957.  Back to cited text no. 3
    
4.
Khan MS, Schwanke Khilji SU, Saw S, Coker RJ. Evidence to inform resource allocation for tuberculosis control in Myanmar: A systematic review based on the SYSRA framework. Health Policy Plan 2017;32:102-9.  Back to cited text no. 4
    
5.
Htwe KK, Kyaw NT, Kumar AM, Kyaw KW, Oo MM, Thwin T, et al. Pre-treatment loss to follow-up and treatment delay among bacteriologically-confirmed tuberculosis patients diagnosed in Mandalay region, Myanmar. Trop Med Health 2019;47:30.  Back to cited text no. 5
    
6.
Tun T, Nyunt WW, Latt KZ, Samaranayaka A, Crump JA, Thinn KK, et al. Drug-resistant tuberculosis among previously treated patients in Yangon, Myanmar. Int J Mycobacteriol 2016;5:366-7.  Back to cited text no. 6
  [Full text]  
7.
Lin KS, Kyaw CS, Sone YP, Win SY. Knowledge on tuberculosis among the members of a rural community in Myanmar. Int J Mycobacteriol 2017;6:274-80.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Yasri S, Wiwanitkit V. Knowledge on tuberculosis in rural Myanmar. Int J Mycobacteriol 2017;6:412-3.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Kawkitinarong K, Suwanpimolkul G, Kateruttanakul P, Manosuthi W, Ubolyam S, Sophonphan J, et al. Real-life clinical practice of using the xpert MTB/RIF assay in Thailand. Clin Infect Dis 2017;64:S171-8.  Back to cited text no. 9
    
10.
Wiwanitkit V. Dengue fever: Diagnosis and treatment. Expert Rev Anti Infect Ther 2010;8:841-5.  Back to cited text no. 10
    


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