1349. Risk Factors for Extrapulmonary Tuberculosis in Greece, a Low Tuberculosis Burden and High Immigrant Receiving Country

Abstract

BackgroundAlthough the most common site of tuberculosis (TB) is the lungs, spreading may occur to any part of the body, resulting in extrapulmonary tuberculosis (EPTB). We conducted a study to describe the clinical and epidemiological features of EPTB in Greece, a low TB burden country (<50 TB cases/million), in which immigrants from high TB burden countries make up >7% of the population.MethodsWe retrieved data for adults presenting with signs/symptoms consistent with EPTB from 2014 to 2015 registries of the Athens Chest Disease Hospital. EPTB was clinically, histologically or microbiologically diagnosed. We recorded age, gender, immigrant, or native status, site of disease, history of diabetes, smoking, and immunological status. Proportion ratios (PR) and 95% confidence interval (CI) were calculated to estimate risk factors for developing EPTB.ResultsWe identified 277 (153 males) adult patients, 254 (91.7%) natives, and 23 (8.3%) immigrants, with signs/symptoms consistent with EPTB. Of 118/277 (42.6%) EPTB cases, 67 (57.6%) were males. No association with gender, diabetes, or smoking was shown between EPTB cases and non-cases. Immigrants were twice as likely to develop EPTB as natives (PR = 1.86 95% CI: 1.38–2.51 P < 0.001). Immigrants from high TB burden countries were 2 times as likely to develop nodal, pericardial, or pleural TB as the native population (Tables 1 and 2). Native patients > 60 years of age presenting with lymph node enlargement or with a pleural effusion were 3 times as likely to have TB disease as those aged <60 years (Table 2). In contrast, all immigrants with lymph node enlargement were EPTB cases (Table 1) and were <45 years old. Impaired immunological status increased the risk of developing EPTB by 62% in the native population (PR = 1.62 95% CI: 1.20–2.33 P < 0.001).ConclusionIn a low TB burden country, EPTB is associated with old age and weak immune system due to possible extrapulmonary dissemination of latent TB. Considered to be at high-risk for developing EPTB, immigrants from high TB burden countries with signs and/or symptoms consistent with EPTB, albeit not transmitting the disease, need to be priority-wise tested for TB in order to be adequately treated. Disclosures All authors: No reported disclosures.