Effect of Sex, Age, and Race on the Clinical Presentation of Tuberculosis: A 15-Year Population-Based Study

Abstract

Abstract. Extrapulmonary tuberculosis (EPTB) is an important health problem that may cause serious morbidity and diagnostic challenges. We conducted a case-control study involving 5,684, approximately 99% of bacteriologically confirmed TB patients (including 1,925 EPTB cases) diagnosed in Denmark and Greenland during 1992-2007 to gain insight to the role of host factors in EPTB pathogenesis. Among patients from Somalia and Asia, persons 25-44 and 45-64 years of age were more likely to have EPTB than persons 15-24 years of age. In contrast, among persons from Greenland, the two oldest age groups were significantly less likely to have EPTB than the youngest age group. For all the age groups, the odds for having EPTB was significantly higher among patients from Somalia and Asia and significantly lower among the patients from Greenland than among patients from Denmark. Furthermore, the occurrence of specific types of EPTB significantly varied among different age groups or origins. International Reference Laboratory of Mycobacteriology is the only laboratory in Denmark that performs mycobacterial culturing confirming TB diagnosis to assist in the national TB surveillance system. For the present study, a database without identifiers of the study subjects was used. This study was reviewed and approved by the health sciences institutional review board of the University of Michigan, the Danish National Ethical Committee, and the Danish Data Protection Agency.Study design and case definitions. This study is a casecontrol study aiming at characterizing TB patients with different anatomic site involvement and identifying risk factors for having EPTB. On the basis of the origin of the specimens and clinical manifestations, the study patients were diagnosed as having pulmonary TB, extrapulmonary TB, or both. For this study, patients with TB exclusively in their lungs were classified as pulmonary TB (designated PTB). Patients with EPTB were categorized into two subgroups (EPTB alone and EPTB plus PTB) on the basis of whether they had TB exclusively at extrapulmonary tissue or organs or in pulmonary and extrapulmonary sites. These three groups were generated to compare the distribution of demographic characteristics between the PTB group and the EPTB alone group, and between the PTB group and the EPTB plus PTB group. In addition, patients with EPTB were grouped into seven categories, according to the classification of EPTB by the American Thoracic Society and the Centers for Disease Control and Prevention.11 These seven categories (also called forms) include bone or/and joint TB, pleural TB, genitourinary TB, peritoneal TB, meningeal TB, lymphatic TB, and other. The distributions of the seven categories were compared between sexes, among different age groups, and between persons of different origins, respectively. Because of national legislation, we did not have access to HIV status of individual patients, but because TB is an acquired immunodeficiency syndrome disease (AIDS)-defining disease, we knew the annual number of HIV-...

A review of paediatric tuberculosis in Denmark: 10-year trend, 2000–2009

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The outcome of tuberculosis treatment in subjects with chronic kidney disease in Brazil: a multinomial analysis

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Mycobacterium tuberculosis Outbreak Strain of Danish Origin Spreading at Worrying Rates among Greenland-Born Persons in Denmark and Greenland

“…GL has some of the highest rates of pulmonary TB in the world (26). In this study, 93% of all the genotyped M. tuberculosis culture-positive TB patients in GL had pulmonary TB, among whom 53% were sputum smear positive.…”