Analysis of circumstances regarding deaths from tuberculosis in inhabitants of the Toruń Province in the years 1990-1993 as an important factor in assessing the causes of tuberculosis treatment failure

The aim of this study was to verify the diagnoses of tuberculosis in 98 cases of death from tuberculosis (TB) in Toruń province in the years 1990-1993. The data of the official register of death were compared, with the hospital records and with the autopsy reports. Tuberculosis was accepted as the cause of death in all patients treated for sputum positive tuberculosis, and also in those in whom pathological proof of tuberculosis existed. In addition tuberculosis was accepted as the cause of death in 6 patients in whom no bacteriological examination was done, but who were tuberculosis contacts and who had the radiological picture of the lung compatible with tuberculosis. Those patients were admitted to hospital in terminal state and the permission for autopsy was refused. Tuberculosis was excluded as the cause of death in those who were treated for tuberculosis but were considered cured and also in those in whom a proof of other severe disease existed. Seventy two cases of tuberculosis death were officially registered in the above-mentioned time. In 23 of the 72 cases tuberculosis was excluded. Additionally 26 patients who died of tuberculosis were officially registered as death from other causes. After verification have found that 75 patients died of tuberculosis. In 26 of them the diagnosis was established only after death during the autopsy examination and/or positive culture for tubercle bacilli. In 27 patients tuberculosis was diagnosed very late, 15 days before death in 12 and 30 days in other 15 patients. In 19 patients the diagnosis was established 30 days or later before death. In majority of them, however, the treatment was interrupted or proceeding irregularly. It is concluded that: the real number of death from tuberculosis was similar to the registered although the errors in registered deaths from TB are in two directions; the main cause of death from TB in Toruń province in the years 1990-1993 was the late diagnosis; the late diagnoses of tuberculosis was stabilized mainly in those who died at home and also in those who were admitted to hospital in critical state and died during the first two weeks of hospitalization.