Evaluation of treatment response in extrapulmonary tuberculosis in a low-resource setting

Melissa Davidsen Jørstad,Msafiri Marijani,Anne Ma Dyrhol-Riise,Lisbet Sviland,Tehmina Mustafa,Jörg Aßmus

doi:10.1186/s12879-019-4034-z

Melissa Davidsen Jørstad, Msafiri Marijani + Show 4 more

Open Access

https://doi.org/10.1186/s12879-019-4034-z

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Abstract

BackgroundDiagnosing extrapulmonary tuberculosis (EPTB) is challenging and many patients are initiated on empirical anti-TB treatment without a laboratory confirmed diagnosis. Monitoring treatment response is thus important to ensure correct diagnosis and proper disease management. The definition of satisfactory response to treatment in EPTB remains unclear. The objectives of this study were to describe the clinical presentation of EPTB and the effect of treatment on clinical parameters. Further, to assess if simple clinical parameters, without laboratory data, could evaluate treatment response.MethodsProspective cohort study of presumptive EPTB patients at Mnazi Mmoja Hospital, Zanzibar. By using a composite reference standard, patients were categorized as TB or non-TB cases. The TB patients were followed during anti-TB treatment.ResultsThere were 64 TB and 62 non-TB cases. The frequency of symptoms at baseline were comparable in TB and non-TB patients, with lymphadenitis and pleuritis as the most common manifestations. Among TB cases, there was a trend towards regression of lymphadenopathy after 2 months, and at treatment completion 24/28 (86%) cases showed full regression. Weight gain ≥5% was reported in 36/49 (73%) of the TB patients at 2 months and in 38/46 (83%) at treatment completion. After 2 months of treatment, a combination of clinical parameters; improvement of symptoms (50/50), ≥5% weight gain (36/49) and regression of physical signs (45/49) correlated with the treatment response.ConclusionsAn algorithm including only simple clinical parameters could be used as an easy tool to assess treatment responses in low-resource settings. However, this needs to be tested on a larger sample size.

Highlights

Diagnosing extrapulmonary tuberculosis (EPTB) is challenging and many patients are initiated on empirical anti-TB treatment without a laboratory confirmed diagnosis
The objectives of this study were to describe the clinical presentation of EPTB among patients presenting at Mnazi Mmoja Hospital (MMH), Zanzibar, and to describe the effect of anti-TB treatment on clinical parameters
In this study, we describe the clinical presentation of various forms of EPTB and changes in clinical parameters during the course of anti-TB treatment

Summary

Introduction

Diagnosing extrapulmonary tuberculosis (EPTB) is challenging and many patients are initiated on empirical anti-TB treatment without a laboratory confirmed diagnosis. To assess if simple clinical parameters, without laboratory data, could evaluate treatment response. Extrapulmonary tuberculosis (EPTB) accounts for 15% of the notified incident tuberculosis (TB) cases [1]. Laboratory confirmation of EPTB is challenging due to the paucibacillary nature of disease and limited resources in high-TB endemic settings. The diagnosis is often made only on medical history and clinical signs and many patients are started on empirical. Jørstad et al BMC Infectious Diseases (2019) 19:426 invasive procedures, it would be useful to assess response to treatment in EPTB by using simple clinical criteria. In contrast to PTB, the EPTB patients are not followed systematically by the TB programme during anti-TB treatment. Symptoms and signs are often not documented in the TB records and the only information available is “treatment completed”, which does not always correspond to successful remission

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