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Portugal&#41; in the months of May and June of 2012&#46; Data were complemented by consulting clinical files&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the period studied 54 patients were included&#44; 37 &#40;68&#46;5&#37;&#41; were male&#44; and mean age 48&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;2 years&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnosis was made by passive screening in 50 patients &#40;92&#46;6&#37;&#41;&#44; radiologic findings in 3 patients &#40;5&#46;6&#37;&#41; and contact screening in 1 patient &#40;1&#46;8&#37;&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The first healthcare entity that the patients consulted was&#58; 20 patients &#40;37&#37;&#41; to the emergency department&#44; 17 patients &#40;31&#46;5&#37;&#41; to a general practitioner&#44; 9 patients &#40;16&#46;7&#37;&#41; for a hospital appointment&#44; 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contribution</span><p id="par0090" class="elsevierStylePara elsevierViewall">Raquel Duarte and Vanda Areias devised the study&#46; Vanda Areias worked up the draft manuscript&#46; Vanda Areias and In&#234;s Neves collected the data&#46; Raquel Duarte and Aurora Carvalho revised the draft&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the editor
Mycobacterium tuberculosis, how long did you walk?
Mycobacterium tuberculosis, quanto tempo passeaste?
V. Areiasa,
Corresponding author
vandareias@hotmail.com

Corresponding author.
, I. Nevesb, A. Carvalhoc,e, R. Duartec,d,e,f,g
a Pulmonology Service, Hospital de Faro, Portugal
b Pulmonology Service, Hospital de São João, EPE, Portugal
c Centro de Diagnóstico Pneumológico de Vila Nova de Gaia, Portugal
d Centro de Referência de Tuberculose Multi-resistente da Região Norte, Portugal
e Pulmonology Service, Centro Hospitalar de Vila Nova de Gaia, Portugal
f Medicine College, Universidade do Porto, Portugal
g Instituto de Saúde Publica, Universidade do Porto, Portugal
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Portugal&#41; in the months of May and June of 2012&#46; Data were complemented by consulting clinical files&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the period studied 54 patients were included&#44; 37 &#40;68&#46;5&#37;&#41; were male&#44; and mean age 48&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;2 years&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnosis was made by passive screening in 50 patients &#40;92&#46;6&#37;&#41;&#44; radiologic findings in 3 patients &#40;5&#46;6&#37;&#41; and contact screening in 1 patient &#40;1&#46;8&#37;&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The first healthcare entity that the patients consulted was&#58; 20 patients &#40;37&#37;&#41; to the emergency department&#44; 17 patients &#40;31&#46;5&#37;&#41; to a general practitioner&#44; 9 patients &#40;16&#46;7&#37;&#41; for a hospital appointment&#44; 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respectively&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Variables like gender&#44; age&#44; education level&#44; drug addiction&#44; patients infected with human infection virus were not associated with a delayed diagnosis&#46; From the 50 patients with symptoms&#44; 25 patients took under 15 days to seek access to the health care system and the others took more than 15 days&#46; Patients who took less than 15 days to access the health care system went mainly to the emergency department &#40;48&#37;&#41;&#44; while patients who took over 15 days were observed mainly by a general practitioner &#40;52&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41;&#46; The median time from the first appointment and diagnosis was 56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>87 days &#40;minimum 1 day&#44; maximum 512 days&#41;&#46; Patients with respiratory symptoms had on average a quicker diagnosis than the others &#40;37&#46;9 <span class="elsevierStyleItalic">versus</span> 127 days&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In 21 patients the diagnosis was made in less than 15 days&#46; The majority of patients in whom the diagnosis was made in under 15 days&#44; were first observed in the emergency department &#40;57&#46;1&#37;&#41;&#44; while patients whose diagnosis took longer than 15 days were observed mainly by a general practitioner &#40;39&#46;4&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#41;&#46; The median time from onset of symptoms and diagnosis was 92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>103 days &#40;minimum 3 days&#44; maximum 559 days&#41;&#46; In our study we observed a delay between the onset of the symptoms and the first observation by a health care entity&#46; In low-middle income countries this delay is 31&#46;7 days and in high income countries it is 25&#46;8 days&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> In our study we obtained an average similar to low-middle income countries&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We observed an unacceptable delay between the first observation by a health care official and diagnosis&#46; The average time reported in low-middle income countries is 28&#46;4 days &#40;2&#8211;87 days&#41; and in high income countries is 21&#46;5 days &#40;7&#8211;36 days&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> which are lower than our results&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">These results suggest the need to revise&#47;implement strategies for earlier diagnosis of tuberculosis&#46; Tuberculosis diagnosis delay is very important in transmission dynamics and TB prevention&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">It is important to run educational programs for the general population&#44; so that patients can recognize symptoms and go earlier to a health care centre&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors&#8217; contribution</span><p id="par0090" class="elsevierStylePara elsevierViewall">Raquel Duarte and Vanda Areias devised the study&#46; Vanda Areias worked up the draft manuscript&#46; Vanda Areias and In&#234;s Neves collected the data&#46; Raquel Duarte and Aurora Carvalho revised the draft&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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