BMJ Case Reports 2017; doi:10.1136/bcr-2016-218953

Delayed diagnosis of pulmonary tuberculosis in a 13-year-old Malawian boy

  1. Nichola Sandys
  1. Paediatric Department, Nkhoma Mission Hospital, Nkhoma, Malawi
  1. Correspondence to Dr Niall Johnston, nijohnst{at}
  • Accepted 23 March 2017
  • Published 26 April 2017


Childhood tuberculosis (TB) is a significant global health burden. There are more than 1 million new cases of childhood TB annually. Despite this, many national TB control programs largely focus on identification and treatment of smear positive adults. Early case detection is essential if childhood TB is to be controlled and eradicated.

Delayed diagnosis of TB is associated with more advanced disease and worse treatment outcomes. Younger children who go undiagnosed for long periods are at risk of developing severe pulmonary and extrapulmonary disease, such as meningitis. Additionally, advanced childhood TB is a common respiratory cause of death in TB-endemic areas. Undoubtedly, delayed diagnosis contributes significantly to TB-related morbidity and mortality.

Diagnostic delay may be divided into patient delay, the duration between development of symptoms and presentation to healthcare provider, and healthcare provider delay, the duration between presentation and initiation of appropriate treatment.


  • Contributors NJ identified and managed the case. NJ and NS were both responsible for manuscript preparation, figure design, revision and final production.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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