Delays in presentation and diagnosis of pulmonary tuberculosis: a retrospective study of a tertiary health service in Western Melbourne, 2011-2014.

BACKGROUND: Effective tuberculosis (TB) control relies on early diagnosis and prompt treatment commencement. AIM: To investigate delays in presentation and diagnosis of pulmonary TB (PTB) in a low incidence setting in Western Melbourne. METHODS: A single-centred retrospective observational cohort study of symptomatic patients ≥ 18 years newly diagnosed with PTB that were commenced on treatment between 1 December 2011 and 1 December 2014 at a tertiary teaching hospital in Western Melbourne. Main outcome measures included median duration of patient, health system and total delays to diagnosis of PTB and clinical factors associated with prolonged patient (>35 days) and health system (>21 days) delay. RESULTS: A total of 133 patients were included. The median (range) duration of patient, health system and total delay to diagnosis were 28 (0-610), 18 (0-357) and 89 (1-730) days respectively. Prolonged patient delay was associated with being from a country with an annual TB incidence of <50/100 000 (odds ratio (OR) 5.98, 95% confidence interval (CI) 1.19, 29.98) and diabetes mellitus (OR 3.02, 95% CI 1.04, 8.78) in multivariate analysis. Being Australian-born or a resident of Australia ≥6 years (OR 0.03, 95% CI 0.12, 0.74; OR 0.30, 95% CI 0.00, 0.033 respectively) was associated with reduced patient delay. CONCLUSIONS: In this low-incidence, high-resource setting, patient delays contribute most to total delay in PTB diagnosis. Strategies addressing this aspect of the TB diagnosis pathway, such as health literacy and promotion programmes for new migrants and raised primary healthcare awareness, could have the largest impact on reducing total PTB diagnosis delays.

Hospitalised adult patients with pandemic (H1N1) 2009 influenza in Melbourne, Australia.

OBJECTIVE: To describe the case characteristics and outcomes of patients hospitalised with pandemic (H1N1) 2009 influenza infection during the first 2 months of the epidemic. DESIGN, PARTICIPANTS AND SETTING: Prospective case series of 112 patients admitted to seven hospitals in Melbourne with laboratory-confirmed pandemic (H1N1) 2009 influenza between 1 May and 17 July 2009. MAIN OUTCOME MEASURES: Details of case characteristics, risk factors for severe disease, treatment and clinical course. RESULTS: Of 112 hospitalised patients, most presented with cough (88%) and/or fever (82%), but several (4%) had neither symptom. A quarter of female patients (15) were pregnant or in the post-partum period. Patients presenting with multifocal changes on chest x-ray had significantly longer hospital lengths of stay, and were more likely to require intensive care unit admission. Thirty patients required admission to an intensive care unit, and three died during their acute illness. The median length of intensive care admission was 10.5 days (interquartile range, 5-16 days). CONCLUSIONS: This study highlights risk factors for severe disease, particularly pregnancy. Clinical and public health planning for upcoming influenza seasons should take into account the spectrum and severity of clinical infection demonstrated in this report, and the need to concentrate resources effectively in high-risk patient groups.