TY - JOUR T1 - Delays in diagnosis and treatment of extrapulmonary tuberculosis in Guatemala JF - BMJ Case Reports DO - 10.1136/bcr-2017-220777 VL - 2017 SP - bcr-2017-220777 AU - Pooja Ajay Shah AU - Merida Coj AU - Peter Rohloff Y1 - 2017/10/07 UR - http://casereports.bmj.com/content/2017/bcr-2017-220777.abstract N2 - 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. ER -