Abstract
BackgroundIn sub-Saharan Africa, there is a dearth of published literature on extrapulmonary tuberculosis (EPTB).ObjectiveTo describe demographic, diagnostic and HIV-status characteristics of patients with EPTB in Bénin, their treatment outcomes, and among those who completed their treatment in the Centre National Hospitalier de Pneumo-Phtisiologie (CNHP-P), the proportion whose bodyweight increased during treatment.Material and FindingsThis was a retrospective cohort study with comparisons made between EPTB and new smear-positive pulmonary tuberculosis (NPTB) patients diagnosed in the country from January to December 2011. There were 383 EPTB patients (9% of all TB cases) with a mean age of 35 years, male/female ratio of 1.3 and important regional variation. There were significantly more females (p = 0.001), children <15years (p<0.001) and HIV-positive patients (p = 0.005) with EPTB compared with NPTB. Pleural effusion, spinal and lymph node tuberculosis accounted for 66% of all EPTB. Children <15 years represented 16% of cases, with lymph node disease being most common among them (p<0.001). Of 130 EPTB patients registered in CNHP-P, 7% had a confirmed bacteriological/histological diagnosis. There were 331 (86%) patients who successfully completed treatment. More patients with EPTB were lost-to-follow-up compared with NPTB (p<0.001) with all these patients from one region. The best treatment completion rates were in children <15 years (OR:3.5, 95%CI:1.0–14.8) while patients with pleural effusion and ascites had the worst outcomes. Of 72 HIV-coinfected patients, 88% were on antiretroviral therapy (ART). HIV-positive status was associated with poor outcomes while those on ART fared better. In the CNHP-P, more than 80% who completed their treatment showed an increase in bodyweight and this was more evident in HIV-positive compared with HIV-negative patients (p = 0.03).ConclusionPatients with EPTB generally do well in Bénin, although the TB Programme would benefit through more attention to accurate diagnosis and earlier start of ART in HIV-infected patients.
Highlights
Patients with extrapulmonary tuberculosis (EPTB), i.e., tuberculosis (TB) without associated lung involvement, usually receive less priority in national TB Programmes
Patients with EPTB generally do well in Benin, the TB Programme would benefit through more attention to accurate diagnosis and earlier start of antiretroviral therapy (ART) in HIV-infected patients
We aimed to describe the pattern of disease in patients registered as EPTB, their treatment outcomes and among those who completed their treatment in the Centre National Hospitalier de Pneumo-Phtisiologie (CNHP-P), the proportion whose weight increased during the course of treatment
Summary
Patients with extrapulmonary tuberculosis (EPTB), i.e., tuberculosis (TB) without associated lung involvement, usually receive less priority in national TB Programmes. In populations with a low prevalence of HIV infection, these patients usually represent 15% to 20% of all TB cases. This proportion is thought to be higher in populations with a high prevalence of HIV infection [2], the latter mostly occurring in subSaharan Africa. Diagnosis in many low income countries is often based on presumptive and circumstantial evidence, with the consequence of a possible misdiagnosis [4]. In sub-Saharan Africa, there is a dearth of published literature on extrapulmonary tuberculosis (EPTB)
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