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Delays in diagnosis and treatment of extrapulmonary tuberculosis in Guatemala
  1. Pooja Ajay Shah1,
  2. Merida Coj2,
  3. Peter Rohloff3,5
  1. 1UCSF School of Medicine, San Francisco, California, USA
  2. 2Wuqu' Kawoq-Maya Health Alliance, Santiago, Sacatépequez, Guatemala
  3. 3Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  4. 5Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Peter Rohloff, prohloff{at}


A 23-year-old indigenous Guatemalan man presented in 2016 to our clinic in Sololá, Guatemala, with 10 months of recurrent neck swelling, fevers, night sweats and weight loss. Previously, he had sought care in three different medical settings, including a private physician-run clinic, a tertiary private cancer treatment centre and, finally, a rural government health post. With assistance from our institution’s accompaniment staff, the patient was admitted to a public tertiary care hospital for work-up. Rifampin-susceptible tuberculosis was diagnosed, and appropriate treatment was begun. The case illustrates how low tuberculosis recognition among community health workers and health system segmentation creates obstacles to appropriate care, especially for patients with limited means. As a result, significant diagnostic and treatment delays can occur, increasing the public health burden of tuberculosis.

  • global health
  • TB and other respiratory infections
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  • Contributors PAS drafted the manuscript. MC and PR critically revised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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