High proportion of extrapulmonary tuberculosis in a low prevalence setting: a retrospective cohort study

Abstract

Objectives The proportion of extrapulmonary tuberculosis (EPTB) cases in the United States (US) has been rising due to a slower rate of decline in EPTB compared to pulmonary tuberculosis (PTB). The purpose of this study was to characterize the clinical and treatment differences between EPTB and PTB patients, and identify patient factors associated with EPTB. Study Design We performed a retrospective cohort study of active tuberculosis (TB) cases treated at the Baltimore City Health Department between 2008 and 2013. Methods We categorized patients as having “only PTB” (infection in the lung parenchyma), “EPTB/PTB” (infection in the lung and an additional site), and “only EPTB” (infection not involving the lung). Pearson's χ squared tests were used to evaluate categorical variables and compare clinical and demographic differences between only PTB, only EPTB, and EPTB/PTB patients. Student t-tests and one-way analysis of variance tests were utilized to assess continuous variables and to compare treatment differences. Results One hundred and sixty-three patients were treated for TB; 39.3% had some form of EPTB (either EPTB/PTB or only EPTB). There was no difference found between EPTB, PTB, and EPTB/PTB patients with respect to HIV status, gender, race, foreign-born status, or mean age. Patients with only EPTB were less likely than patients with some form of PTB (only PTB or EPTB/PTB) to present with cough (30.4% vs. 61.5%; p<0.001), night sweats (10.9% vs. 39.3%; p<0.001), and weight loss (28.3% vs. 47.9%; p=0.023). Patients some form of EPTB were also more likely to be hospitalized post-diagnosis compared to patients with only PTB (39.1% vs. 20.2%; p=0.009), and to have longer mean durations of treatment (37.9 weeks [SD=11.1] vs. 31.8 weeks [SD=8.1]; p<0.001). Conclusions EPTB patients present with atypical symptoms, undergo prolonged treatment, and experience increased hospitalizations. In order to improve diagnostic algorithms and treatment modalities, EPTB must be further characterized.

Association of HIV infection with extrapulmonary tuberculosis: a systematic review

“…Most of these publications included an effect measure of the association of HIV with EPTB as a secondary analysis rather than the primary one. Nine of these studies were based on surveillance data or on analyses of city or statewide registry data [27, 17-20, 23, 24, 29, 11]. Seven studies were conducted in hospitals [26, 28, 21, 22, 30, 31, 25] , although a few studies were more rigorous and included only incident cases at the hospital.. Study settings were also heterogeneous, ranging from Asia (Taiwan), South America (Brazil), Europe (Spain and Portugal), Africa (Ethiopia, South Africa, Zambia and Cameroon) and North America (US states of Florida, Maryland, Tennessee, Texas and Arkansas) ( Table 1 ).…”

“…Using the modified Newcastle-Ottawa criteria ( Appendix Table 1 ), four of the studies [17, 20, 25, 29] had a low risk of bias, ten [18, 19, 21, 22, 24, 26-28, 30, 31] had a medium risk of bias and two [23, 11] had a high risk of bias. Despite the cross-sectional design, studies by Wilkinson and Moore; Gonzalez et al; Fiske et al; and Sama et.…”

Trends in diagnostic techniques and factors associated with tuberculosis treatment outcomes in Lesotho, 2010–2015

“…The fact that extra-pulmonary TB emerged as a significant factor (p = 0.002) associated with unsuccessful treatment outcome highlights that extra-pulmonary TB is more difficult to treat in this population. Sama et al 21 highlight that there is a need for new drugs and/or dosage forms to treat extra-pulmonary TB.…”

Comparison of clinical and pathological features of lymph node tuberculosis and histiocytic necrotizing lymphadenitis

“…According to some recent reports, approximately 19.3%-39.3% of patients present with extra-pulmonary tuberculosis (EPTB) or EPTB concurrent with pulmonary involvement in active TB disease [3][4][5]. With the increasing prevalence of HIV infection, the proportion of EPTB among all TB cases has been expanding [6,7].…”