Epidemiology of tuberculous lymphadenitis in Africa: A systematic review and meta-analysis

Abstract

Introduction Tuberculous lymphadenitis is the most frequent form of extra-pulmonary TB (EPTB) and accounts for a considerable proportion of all EPTB cases. We conducted a systematic review of articles that described the epidemiological features of TBLN in Africa. Methods Any article that characterized TBLN cases with respect to demographic, exposure and clinical features were included. Article search was restricted to African countries and those published in English language irrespective of publication year. The articles were retrieved from the electronic database of PubMed, Scopus, Cochrane library and Lens.org. Random effect pooled prevalence with 95% CI was computed based on Dersimonian and Laird method. To stabilize the variance, Freeman-Tukey double arcsine root transformation was done. The data were analyzed using Stata 14. Results Of the total 833 articles retrieved, twenty-eight articles from 12 African countries fulfilled the eligibility criteria. A total of 6746 TBLN cases were identified. The majority of the cases, 4762 (70.6%) were from Ethiopia. Over 77% and 88% of identified TBLN were cervical in type and naïve to TB drugs. Among the total number of TBLN cases, 53% were female, 68% were in the age range of 15–44 years, 52% had a history of livestock exposure, 46% had a history of consuming raw milk/meat and 24% had history of BCG vaccination. The proportion of TBLN/HIV co-infection was much lower in Ethiopia (21%) than in other African countries (73%) and the overall African estimate (52%). Fever was recorded in 45%, night sweating in 55%, weight loss in 62% and cough for longer than two weeks in 32% of the TBLN cases. Conclusions TBLN was more common in females than in males. The high prevalence of TBLN in Ethiopia did not show directional correlation with HIV. Population based prospective studies are warranted to better define the risk factors of TBLN in Africa.

Incidence, risk factors and clinical characteristics of extra‐pulmonary tuberculosis patients: a ten‐year study in the North of Iran

“…Fever and night sweating were the most frequent complaints. In a systematic review study, fever (45%) and night sweating (55%) were the main cardinal systemic symptoms among EPTB cases [5]. Along with the general symptoms of the disease in most EPTB cases, specific symptoms are related to the part of the infected organ: spinal TB may cause back pain, as reported by Garg et al [37].…”

“…In most countries, the incidence of EPTB has increased and it can be a challenge for the strategy of reducing TB and the 'end TB strategy' set by WHO [2][3][4]. On average, 15% of the clinical forms of TB can be EPTB; its rate varies from 8% in the western Pacific region to 30% in the eastern Mediterranean region [5][6][7].…”

“…Some risk factors are involved, such as host-pathogen interactions and the immune system. The main risk factors associated with EPTB vary widely and include human immunodeficiency virus (HIV) co-infection, female sex, age (young children and/or above 65 years of age), race and diabetes [5,13,15]. Some of these factors lead to the immune system dysfunction due to decreased number of immune cells, production of cytokines and proliferation of tissue cells [8,16].…”

Cervical lymphadenopathy of Togolese children in a tropical context: clinicopathological study

“…9,10 TB is usually easily diagnosed on TB defining imaging, subdermal testing and cultures. 12 Fine-needle aspiration, which can be performed on an outpatient basis in a primary healthcare setting, with a rapid, sensitive diagnostic technique may contribute substantially to the effective management of mycobacterial infection in children. 13 The implications of rapid, accurate diagnosis include access to appropriate, adequate therapy and less costly further investigations.…”

Diagnosis of Extra-Pulmonary Tuberculosis by MTB/RIF from a Fine Needle Aspirate Biopsy: Case Report

“…Tuberculosis (TB) is a public health challenge affecting the greater part of the world population. It most frequently affects the pulmonary system (PTB) but may primarily affect or spread to extra-pulmonary sites (EPTB) [1].…”