Epidemiology of Extrapulmonary Tuberculosis in Brunei Darussalam: A retrospective cohort study

Abstract

Objectives: We reported the epidemiology of extrapulmonary tuberculosis (EPTB) in Brunei Darussalam from January 2001 to December 2018. Design or methods: A retrospective cohort study was conducted where sociodemographic and clinical data for all active TB cases were collected. Factors associated with developing EPTB were investigated using logistic regression. Chi-square trend test was used to determine any trends during the 18-year study period. Results: We identified 3,916 TB cases, among which 743 (19.0%) were EPTB cases. Lymphatic (44.8%) and pleural (19.4%) EPTB were most common. The main modes of diagnosis were tissue biopsy (73.6%) and radiologic assessment (18.3%). Treatment success and mortality rate were 79.7% and 7.0%, respectively. Associations with specific EPTB types varies with age-group and gender. Younger age-group (aOR ≥1.94) and females (aOR: 2.45 [95%CI: 1.94,3.11]) had higher adjusted odds of developing lymphatic EPTB, but had lower adjusted odds of developing pleural EPTB [younger age-group (aOR ≤0.54) and female (aOR: 0.41 [95%CI: 0.17,0.90])]. No significant trend differences were observed for overall and specific EPTB types. Conclusions: Understanding EPTB epidemiology is important as it also contributes to the overall TB burden in a country. Future studies could be done to analyse the association between EPTB and presence of co-morbidities.

Tuberculous pleuritis: clinical presentations and diagnostic challenges

“…TBP is amongst the top two most common subtypes of EPTB, but its reported prevalence varies with geographical location, methodology of review (analysis of diagnostic coding or manual review of clinical registry), and definition of disease (microbiologically proven or based on clinical diagnosis). Prevalence of TBP ranged widely from 2.2 to 31.4% of all TB cases and from 9.2 to 67.0% among all EPTB patients [2,3,5–12,13 ▪▪ ,14–17] (Table 1). In a Chinese registry containing 472,920 TBP patients, there was an annual increase in the incidence of TBP from 0.4 to 3.3 per 100 000 population between 2005 and 2018 [18 ▪ ].…”

“…Systemic complaints, for example weight loss, may be absent [11,25], while anaemia and hypoalbuminaemia are often present [25]. Among patients with EPTB, TBP is more common in men [10,14,16], older age groups [12,16] and HIVinfected individuals [7]. TBP typically presents with subacute unilateral pleural effusion, which is more likely right-sided [11,26].…”