High Proportion Of Extrapulmonary Tuberculosis Research Articles

Isolated Chest Wall Tuberculosis Presenting As an Abscess

Lebanon is a relatively low Tuberculosis burden country but has a high proportion of extrapulmonary tuberculosis. Tuberculosis involving the chest wall is found in around 1% of all skeletal tuberculosis cases. We present the case of an 81-year-old immunocompetent patient who presented with 3 months history of a painful lump in the anterior chest wall. PCR for MTB (mycobacterium tuberculosis) was positive and a diagnosis of the tubercular abscess of the chest wall was made mimicking a pyogenic abscess.

Epidemiology and risk factors for extrapulmonary tuberculosis in Lebanon.

SETTING: Lebanon is a relatively low TB-burden country, but has a high proportion of extrapulmonary tuberculosis (EPTB). Concern has been expressed that Syrian-born refugees could add to the TB burden and rates of EPTB: since 2011, >1 000 000 Syrian refugees have entered Lebanon.OBJECTIVE: The Lebanese National Tuberculosis Programme (NTP) sought to identify factors for the high proportion of EPTB and to assess the potential impact of Syrian refugees.DESIGN: NTP line-listed data from 2014-2015 were analyzed with logistic regression identified risk factors for EPTB. A trend analysis for 2011-2015 assessed TB burden by nationality and site of TB.RESULTS: Of 1347 reported TB cases from 2014 to 2015, 507 (38%) were EPTB and 46% were Lebanese. In analysis limited to Lebanese-born, the proportion of EPTB cases was relatively stable, 47% in 2011 and 52% in 2015. Modeling identified risk factors for EPTB as being female (aOR 1.79, 95%CI 1.39-2.32) and 5-15 years old (aOR 3.31, 95%CI 1.47-7.45) compared with children aged <5 years. Between 2011 and 2015, the proportion of TB cases among Syrian-born increased from 3% in 2011 to 21% in 2015 (P < 0.001); however, the proportion of EPTB versus PTB cases among Syrians remained stable (P = 0.264).CONCLUSION: Syrian TB cases increased almost 10-fold in five years (2011-2015) but their contribution to EPTB did not change. The high proportion of EPTB in Lebanon and those aged 5-15 years merits further investigation.

The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea.

Papua New Guinea (PNG) has an emerging tuberculosis (TB) epidemic which has become a national public health priority. In Western Province, there are few data about TB outside Daru and the South Fly District. This study describes the epidemiology of TB diagnosed at Balimo District Hospital (BDH) in the Middle Fly District of Western Province, PNG. All patients (n = 1614) diagnosed with TB at BDH from April 2013 to February 2017 were recorded. Incidence of reported new cases was calculated for the combined Balimo Urban and Gogodala Rural local level government areas. Analyses investigated patient demographic and clinical information, differences between pulmonary and extrapulmonary TB patients, and predictors of treatment failure. The average case notification rate (2014-2016) was 727 TB cases per 100 000 people per year. One-quarter of TB cases were in children, and 77.1% of all cases had an extrapulmonary TB diagnosis. There was a 1:1.1 ratio of female to male TB cases. When comparing pulmonary and extrapulmonary TB patients, extrapulmonary TB was more likely in those aged up to 14 years and over 54 years. Extrapulmonary TB was more likely in new patients, and pulmonary TB more likely in previously treated patients. Residence in rural regions was associated with treatment failure. There is a high burden of TB in the Balimo region, including a very high proportion of extrapulmonary TB. These factors emphasise the importance of BDH as the primary hospital for TB cases in the Balimo region and the Middle Fly District, and the need for resources and staff to manage both drug-susceptible and drug-resistant TB cases.

Cytomorphological spectrum of Extra Pulmonary Tuberculosis in Rural Tertiary Care Hospital: A Study

This is estimated that about 1/3 rd of world population is infected with mycobacterium tuberculosis & most of the cases in Asia (55%) and Africa (31%) rest in others. Extra Pulmonary Tuberculosis (EPTB) reversed the epidemiological trend over the last several years. EPTB was has been increasing in absolute numbers and in proportions of all reported TB cases. Since very less data is available on EPTB and its distribution especially from this part of India therefore this study has been planned to assess the pattern of EPTB & the role of Fine Needle Aspiration Cytology (FNAC) in diagnosing these cases. This is a retrospective analysis of patients with peripheral lymphadenopathy & swelling on various sites. All the patients had fine needle aspiration. Smears were made, fixed in 95% alcohol and stained with giemsa, hematoxylin and eosin and Zeihl Neelsen (ZN) stains. The study includes 271 cases of extrapulmonary tuberculosis in which patient age range from one year to more than 51 years. Maximum no. of cases falls in the age group between 11 to 20 years. The mean age was 22.6 years. Females (63%) had higher proportion of EPTB than males (37%). Aspirates were mainly from cervical lymph nodes. Other sites were chest wall, breast, thigh, back etc. Macroscopically, 106 (39%) of the aspirates were purulent and 165 (61%) had necrotic material. Microscopy we divide it in three patterns, Pattern A (Epithelioid granuloma without necrosis) (39.11%); Pattern B (Epithelioid granuloma with necrosis) (45.75%); Pattern C (necrosis/neutrophilic aspirate) (15.12%). Staining for acid-fast bacilli was positive in 47 (17.34%) cases. Early diagnosis of extrapulmonary tuberculosis in a resource-limited setting can be achieved with fine needle aspiration cytology technique (FNAC). This will ensure prompt treatment and thus reduce attendant morbidity and mortality.

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

ObjectivesThe 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 characterise the clinical and treatment differences between EPTB and PTB patients, and identify patient factors associated with EPTB. Study designWe performed a retrospective cohort study of active tuberculosis (TB) cases treated at the Baltimore City Health Department between 2008 and 2013. MethodsWe categorised 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 chi-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 utilised to assess continuous variables and to compare treatment differences. ResultsOne 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 with some form of EPTB were also more likely to be hospitalised postdiagnosis 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). ConclusionsEPTB patients present with atypical symptoms, undergo prolonged treatment, and experience increased hospitalisations. In order to improve diagnostic algorithms and treatment modalities, EPTB must be further characterised.

Extrapulmonary tuberculosis: 7 year-experience of a tertiary center in Istanbul

BackgroundAlthough a decreasing trend of tuberculosis (TB) was reported in Turkey, higher proportion of extrapulmonary tuberculosis (EPT) was revealed. Material and methodsIn this retrospective study, clinical and laboratory data of 141 EPT patients were evaluated for a seven-year period by using descriptive statistics, and parametric and non-parametric tests where appropriate. ResultsThe most frequent types of EPT were meningeal TB (23%) and TB lymphadenitis (21%), respectively. Other types of EPT were skeletal, miliary, peritoneal, abscess, genitourinarial, cutaneous and gastrointestinal involvement which ranged between 18% and 1%. Mean age was 42 and female/male ratio was almost equal. All patients were born in Turkey. Although all of them were permanent residents of Istanbul, 73% of the patients came from East and Southeast Region of Turkey. For the patients, being older than 40years old (p<0.01), having miliary TB (p<0.05) and high CRP levels (p<0.05) were found to be associated with mortality. ConclusionsEPT still remains as a significant morbidity and mortality reason in lower income populations and developing countries. In our study, although all patients were residents of Istanbul approximately two thirds of them have migrated from East and Southeast parts of the country. The relatively high prevelance of tuberculosis cases in Istanbul may be due to the permanent migration from other parts of the country. Early diagnosis and initiation of appropriate treatment are the keys for reducing morbidity and mortality in patients with EPT, particularly in the cases of older ages.

Surveillance data analysis of revised national tuberculosis control program of Kangra, Himachal Pradesh

Background:The annual risk of tuberculosis infection is 1.9% in Himachal Pradesh against a national average of 1%. Revised national tuberculosis control program (RNTCP) in Kangra was introduced in October, 1998. We analyzed the 5-year (2001-2005) RNTCP secondary data from Kangra to evaluate the performance of the program.Materials and Methods:We collected data from all the five tuberculosis units the district. We calculated the following indicators-case detection rate, tuberculosis cases by category-new smear positive (or smear negative but seriously ill) defaulters, relapses and failures, extra-pulmonary, and new smear negative cases. We compared the results with Himachal Pradesh and India. We employed the standardized program indicators-sputum positivity, cure, death, failure and default rates.Results:Extra pulmonary cases ranged in between 56% and 73%, normal being 15-20%. The highest category-1 varies from 42% to 48%. New smear positive case detection rates (78-90%) and cure rates (88-91%) were the highest as compared to figures of the state and country. Failure rate was maximum in Kangra Tuberculosis Units (TU)-6.5% and the default rate was 7.2% in TU Palampur. The tuberculosis cases have fallen down from 6,462/100, 000 in 1999 to 2,195/100, 000 in 2005 following the introduction of RNTCP in 1999. Age specific (15-55 years) and sex-wise males were more affected than the females (59-64%).Conclusions:Continue investment in the program to sustain progress achieved. Investigate the cause of high proportion of extra-pulmonary tuberculosis. Investigate Kangra TU unit with a high default rate.

Analysis of surveillance data of revised national tuberculosis control programme of Kangra, Himachal Pradesh

Background: The annual risk of tuberculosis infection is 1.9% in Himachal Pradesh against a national average of 1%. Revised National Tuberculosis Control Programme (RNTCP) in Kangra was introduced in October, 1998. We analyzed the five year (2001-2005) RNTCP surveillance data from Kangra to evaluate the performance of the programme. Methods: We collected data from all the five tuberculosis units the district. We calculated the following indicators-Case detection rate, tuberculosis cases by category-New smear positive (or smear negative but seriously ill) defaulters, relapses and failures, extra-pulmonary and new smear negative cases. We compared the results with Himachal Pradesh and India. We employed the standardized programme indicators-sputum positivity, cure, death, failure and default rates. Results: Extra pulmonary cases ranged in between 56-73%, normal being 15-20%. The highest Category-1 varies from 42%-48%. New smear positive case detection rates (78%-90%) and cure rates (88%-91%) were the highest as compared to figures of the state and country. Failure rate was maximum in Kangra TU-6.5% and the default rate was 7.2% in TU Palampur. The tuberculosis cases have fallen down from 6462/lac in 1999 to 2195/lac in 2005 following the introduction of RNTCP in 1999. Age specific (15-55 years) and sex wise males were more affected than the females (59%-64%) Conclusion: Continue investment in the programme to sustain progress achieved. Investigate the cause of high proportion of extra-pulmonary tuberculosis. Investigate Kangra TU unit with a high default rate.

Impact of immigration on tuberculosis epidemiology in a low-incidence country

Mycobacterium tuberculosis strains from 349 patients were isolated in western Sweden during the years 2001–2005. Only 26% of the tuberculosis (TB) patients were born in Sweden. All the others were born in any of 42 different countries; 17% in other European countries, 28% in Africa, 16% in Asia, 11% in the Middle East, and 2% in South America. The mean age of the Swedish-born patients was 67 years, while the mean age among the foreign-born patients was 37 years. The male/female ratio was 1.6 among the Swedes and 0.9 among those born abroad. Extrapulmonary manifestations of TB were most common among patients born in Africa while lung infections without extrapulmonary manifestations were most common in patients born in Europe, including Sweden. Spoligotyping showed that patients with T or Beijing strains had more pulmonary TB than extrapulmonary TB, while patients with EAI and CAS strains had a high proportion of extrapulmonary TB. The ancestral and/or evolutionary older PGGI strains were more often isolated from the foreign-born patients than from the Swedish-born patients, who had strains generally being of the evolutionary recent genogroups PGG2/PGG3. We conclude that immigration from countries with a high incidence of TB has a strong impact on the TB epidemiology in western Sweden, a finding that should be taken into account by TB control strategists when developing programmes for eradication of TB in low prevalence settings.

Immune reconstitution inflammatory syndrome of tuberculosis among HIV-infected patients receiving antituberculous and antiretroviral therapy

To determine the frequency, risk factors and mortality rate of immune reconstitution inflammatory syndrome (IRIS) of tuberculosis (TB) in patients co-infected with HIV/TB and receiving antiretroviral therapy (ART). A retrospective study was conducted in Bamrasnaradura Infectious Diseases Institute and Ramathibodi Hospital, Thailand. There were 167 patients with a mean age of 34.5 years. Median (IQR) CD4 cell counts was 36 (15-69) cells/mm(3) and median (IQR) HIV RNA was 427,000 (189,000-750,000) copies/ml. ART was initiated at a median (IQR) duration of 2.2 (1.4-3.7) months after TB treatment. IRIS was identified in 21 (12.6%) patients. Patients with IRIS had a higher proportion of extrapulmonary TB than patients without IRIS (P<0.001). By multivariate analysis, extrapulmonary TB was a risk factor for IRIS (odds ratio=8.225, 95% confidence interval=1.785-37.911, P=0.007). Of 21 patients with IRIS, 15 patients developed IRIS within the first two months of ART. The mortality rate in patients with and without IRIS was not different (9.5% versus 2.1%, P=0.119). The rate of TB IRIS is 13% in patients co-infected with HIV and TB. Extrapulmonary TB is a risk factor for IRIS. Closely monitored clinical care in the first few months of ART initiation and further interventional studies to minimize mortality of TB IRIS are needed.

The molecular epidemiology of Mycobacterium bovis infections in Tanzania

A molecular epidemiological study to determine the zoonotic importance of bovine tuberculosis was carried out in Tanzania. Specimens from human cases of tuberculosis as well as from slaughtered cattle were collected from regions with a high proportion of extrapulmonary tuberculosis. In order to determine the similarity of strains from the two sources, molecular typing techniques, namely RFLP and spoligotyping, were used to determine the genetic profile of the strains involved. The results of pTBN12 typing of M. bovis from cattle and man has shown a rather heterogeneous population of this species spread all over Tanzania, assuming that the present sample is representative. There were 13 different pTBN12 RFLP types encountered. The genetic relatedness between the pTBN12 RFLP patterns indicated a high degree of relatedness (86%) between the dominant pTBN12 genotypes existing in Tanzania. There were 13 different spoligotypes found in this study, whose genetic relatedness was also high (79%). DNA profiles were also confirmed by IS986 RFLP, which revealed that strains have 1-13 copies of IS986. Geographically, there was overlap between pTBN12 RFLP and spoligotypes amongst strains isolated from various parts of Tanzania. The diversity of the RFLP and spoligotype patterns observed in Tanzania probably reflects the extensive internal movements of cattle belonging to pastoralists. The evidence of overlap between DNA fingerprints of M. bovis from cattle and man has once more highlighted a need for synergy of veterinary and medical policies in the control of tuberculosis in Tanzania and probably in other developing countries.

Bone and joint tuberculosis in Denmark: increase due to immigration.

We studied the epidemiology of bone and joint tuberculosis (TB) in Denmark during the period 1993-1997, using data in the national Danish TB register. We found 95 cases, accounting for 4% of all tuberculosis cases and 15% of extrapulmonary cases, giving a mean annual incidence of 0.4 per 10(5) in the period. 26 cases were found among native Danes (3-8 cases per year) with a median age of 66 (10-92) years and giving a mean annual incidence of 0.1 per 10(5). Among immigrants, an increasing number of cases of bone and joint TB were diagnosed, increasing from 5 in 1993 to 28 in 1997, giving a total of 69 cases with a mean age of 35 (11-75) years and a mean annual incidence of 4 per 10(5) in the period. The spine was affected in half of the cases. 28 patients had active TB elsewhere in the same period. In most patients, there were no predisposing or risk factors for disease except for ethnicity. Compared to a study of bone and joint TB in Denmark in the 1980s, the total incidence is the same, but there has been a shift in patients from old Danes to young immigrants. The increasing number of bone and joint TB cases among immigrants is due to recent immigration of Somalian refugees, who have a high incidence of TB and a high proportion of extrapulmonary TB. The diagnosis was often delayed several months or years. This study shows that attention must be paid to this condition, particularly in young patients from an endemic immigrant population.