# Tuberculosis-related hospitalizations in Brazil: a nine-year experience in a high-burden setting

## TL;DR

This study examines TB hospitalizations in Brazil, finding that social vulnerability, HIV coinfection, and delayed diagnosis contribute to severe cases and high mortality.

## Contribution

The study provides insights into the clinical and social factors associated with TB hospitalizations in a high-burden setting in Brazil.

## Key findings

- TB-HIV coinfection was present in 55.3% of hospitalized patients, with most having low CD4+ T-cell counts.
- Diagnostic work-up was the main reason for hospitalization, with a median symptom duration of 3.6 months.
- In-hospital mortality was 17.3%, with malnutrition and thrombocytopenia as significant risk factors.

## Abstract

Tuberculosis (TB) remains a major public health concern globally and in Brazil. Although ambulatory treatment is recommended for most patients, hospitalizations still occur due to severe clinical presentations, social vulnerability, or treatment complications.

We conducted a retrospective, observational study of TB-related hospitalizations at a regional referral tertiary public hospital in São Paulo, Brazil, from 2013 to 2022. Medical records were reviewed to collect epidemiological, clinical, laboratory, and microbiological data.

Among 197 hospitalizations for TB, 73.1% were male, with a mean age of 41.8 years. TB-HIV coinfection was identified in 55.3% of cases, with 83.5% of these patients having CD4+ T-cell counts ≤ 200 cells/mm3. Malnutrition (40.1%), smoking (64.0%), alcohol use (51.6%), and illicit drug use (58.1%) were common. Pulmonary TB occurred in 48.7%, while 29.4% had extrapulmonary TB and 21.8% disseminated forms. Diagnostic confirmation was achieved in 74.1%, including bacilloscopy, culture, molecular test, ADA and biopsy. The main reason for hospitalization was diagnostic work-up (74.1%), with a median symptom duration of 3.6 months. ICU care was required in 23.8% of cases. In-hospital mortality was 17.3%, and significant risk factors included malnutrition and thrombocytopenia.

In this high-burden setting, TB hospitalizations were associated with social vulnerability, HIV coinfection, and delayed diagnosis. The high frequency of severe presentations highlights the importance of early detection and access to molecular testing. Improved integration between outpatient care and hospital services may reduce the need for hospitalization and improve outcomes.