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Luna-Hernández JF, Ramírez-Díaz MDP, Zavala AE, Velázquez-Ramírez DD, Hernández-Ramírez G, Rodríguez-López EI. Factors Associated With Extrapulmonary Tuberculosis in Southeastern Mexico: A Case-Control Study. Cureus 2024; 16:e59739. [PMID: 38841000 PMCID: PMC11152104 DOI: 10.7759/cureus.59739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Extrapulmonary tuberculosis (EPTB) is a disease that can affect any organ or tissue. Due to its potential to cause more dangerous sequelae and the barriers to its timely diagnosis, greater clinical awareness of this disease is crucial. This study aimed to identify the factors associated with EPTB in the population of Oaxaca, Mexico. METHODS This is an unpaired case-control study. The cases were patients with EPTB+ while the controls were patients with pulmonary tuberculosis (PTB+) registered in the Tuberculosis Epidemiological Surveillance System. Sociodemographic, clinical, and microbiological variables were recovered. Bivariate analyses were performed and logistic regression analyses were performed to calculate the odds ratio (OR). RESULTS A total of 75 EPTB+ cases and 300 PTB+ controls were included. Of the total sample, 57.1% were men and 60.3% indigenous. The most frequent clinical presentations of EPTB+ were nodal (21.3%), miliary (21.3%), and breast (20.0%). According to logistic regression analysis, age <40 years (OR: 2.25 (95% CI: 1.13-4.49), female sex (OR: 1.92 (95% CI: 1.03-3.56)], urban residence (OR: 2.25 (95% CI: 1.11-4.55)), comorbidity with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (OR: 3.46 (95% CI: 1.31-9.10)), dyspnea (OR: 2.67 (1.22-5.82)), and adenopathy (OR: 3.38 (95% CI: 1.42-8.06)) were positively associated with EPTB+. CONCLUSION These results can serve as a basis for screening EPTB+, thus improving the preventive and diagnostic capacity of local health services, taking as a starting point women under 40 years of age and patients with HIV/AIDS in urban areas, as well as the presence of adenopathy and dyspnea as clinical characteristics of the disease.
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Affiliation(s)
| | | | - Abel Eduardo Zavala
- Health and Welfare, Inter-American Conference on Social Security, Ciudad de México, MEX
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Singh GR, Sinha A, Anushweta, Sharma R, Saurabh K, Haldar D. Rare Extrapulmonary Tuberculosis: Covert symptoms and Diagnostic Dilemma. Niger Med J 2024; 65:92-100. [PMID: 39006181 PMCID: PMC11238168 DOI: 10.60787/nmj-v65i1-462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
Background Pulmonary tuberculosis may result in haematogenous and lymphatic extension in case of failure of early detection, or immunocompromised status, leading to extrapulmonary tuberculosis. Rare sites of extrapulmonary tuberculosis include the gastrointestinal tract, musculoskeletal system, genital tract, middle ear and pericardium. Histopathological findings of macro-confluent granuloma with or without caseous necrosis, along with detection of acid-fast bacilli (AFB) on Ziehl-Neelsen (ZN) staining, and GeneXpert for detection of Mycobacterium tuberculosis DNA, are key in establishing a diagnosis of tuberculosis. Methodology Biopsy-proven extrapulmonary granulomatous lesions were included in this study. Histopathological evaluation of all extrapulmonary biopsy specimens sent to the Department of Pathology were done for the presence of granuloma and necrosis, and ZN staining for AFB was done in all the cases of granulomatous lesions with or without the presence of necrosis. The same cases, with biopsy specimens sent in normal saline, were re-evaluated in a molecular laboratory with the help of GeneXpert MTB to detect the DNA of Mycobacterium tuberculosis. All biopsy specimens from extrapulmonary sites which were sent to the Department of Pathology were used for DNA extraction. Results Out of the 10 cases of extrapulmonary granulomatous lesions, 8 showed caseous necrosis on microscopy, and 7 showed the presence of acid-fast bacilli on Ziehl-Neelsen staining. GeneXpert detected DNA of Mycobacterium tuberculosis in 9 cases. Conclusion Extrapulmonary tuberculosis rarely occurs as primary, and mostly spreads from lung parenchyma via a haematogenous route. Tuberculosis of the gastrointestinal tract, peritoneum, lymph nodes, and solid viscera are together termed abdominal tuberculosis. Entities like tuberculosis of the pericardium and ear are extremely rare. Extrapulmonary tuberculosis should be a differential in cases of chronic non-responding cases with diagnostic dilemmas. To avoid diagnostic delay, in cases of high suspicion, one should go for biopsy along with ZN staining for diagnostic confirmation as this is cost-effective, followed by GeneXpert for Mycobacterium tuberculosis in highly suspected cases with absent caseous necrosis and negative ZN staining.
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Affiliation(s)
- Guddi Rani Singh
- Department of Pathology, and Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014, India
| | - Anila Sinha
- Department of Pathology, and Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014, India
| | - Anushweta
- Department of Pathology, and Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014, India
| | - Richa Sharma
- Department of Pathology, and Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014, India
| | - Kumar Saurabh
- Department of Pathology, and Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014, India
| | - Debaditya Haldar
- Department of Pathology, and Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar 800014, India
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Chen S, Wang Y, Zhan Y, Liu C, Wang Q, Feng J, Li Y, Chen H, Zeng Z. The incidence of tuberculous pleurisy in mainland China from 2005 to 2018. Front Public Health 2023; 11:1180818. [PMID: 37397728 PMCID: PMC10311513 DOI: 10.3389/fpubh.2023.1180818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/12/2023] [Indexed: 07/04/2023] Open
Abstract
Background Currently, tuberculous pleurisy (TP) remains a serious problem affecting global public health, including in China. Our purpose was to comprehensively understand and identify the incidence of TP in mainland China between 2005 and 2018. Methods The data on registered TP cases from 2005 to 2018 were acquired from the National Tuberculosis Information Management System. We analyzed the demographics, epidemiology, and time-space distribution of TP patients. Then, the effects of potentially influential factors on TP incidences, such as medical expenses per capita, GDP per capita, and population density, were assessed using the Spearman correlation coefficient. Results The incidence of TP increased in mainland China from 2005 to 2018, with a mean incidence of 2.5 per 100,000 population. Interestingly, spring was the peak season for TP, with more notified cases. Tibet, Beijing, Xinjiang, and Inner Mongolia had the highest mean annual incidence. A moderate positive relationship was found between TP incidence, medical expenses per capita, and GDP per capita. Conclusions The notified incidence of TP had an elevated trend from 2005 to 2018 in mainland China. The findings of this study provide insight into the knowledge of TP epidemiology in the country, which can help optimize resource allocation to reduce the TP burden.
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Affiliation(s)
- Shuhan Chen
- Second Clinical College, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Zhan
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Changyu Liu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Wang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Feng
- Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yufeng Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huilong Chen
- Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhilin Zeng
- Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ebrahimzadeh A, Pagheh AS, Mousavi T, Fathi M, Moghaddam SGM. Serosal membrane tuberculosis in Iran: A comprehensive review of evidences. J Clin Tuberc Other Mycobact Dis 2023; 31:100354. [PMID: 36874623 PMCID: PMC9982686 DOI: 10.1016/j.jctube.2023.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Tuberculosis (TB) is among the most common cause of serositis. There are many uncertainties in diagnostic and therapeutic approach to serous membranes tuberculosis. Our aim in the present review is to discuss the regional facilities for timely diagnosis, rapid decision-making and appropriate treatment regarding to serous membranes tuberculosis; with emphasis on situation in Iran. A comprehensive literature searches about the status of serous membranes tuberculosis in Iran were performed in English databases including Google Scholar, Science Direct, Scopus, Pub Med, and Web of Sciences, Persian SID databases, between 2000 and 2021. The main findings of the present review are as follow: a) pleural tuberculosis is more common than pericardial or peritoneal tuberculosis. b) Clinical manifestations are non-specific and so non-diagnostic. c) Smear and culture, PCR and characteristic granulomatous reaction have been used for definitive TB diagnosis by physicians. d) With Adenosine Deaminase Assays and Interferon-Gamma Release Assays in mononuclear dominant fluid, a possible diagnosis of TB is proposed by experienced physicians in Iran. e) In area of endemic for tuberculosis including Iran, a possible diagnosis of TB is enough to begin empirical treatment. f) In patients with uncomplicated tuberculosis serositis, treatment is similar to pulmonary tuberculosis. First line drugs are prescribed unless evidence of MDR-TB is detected. g) The prevalence of drug resistant tuberculosis (MDR-TB) in Iran is between 1% and 6%, and are treated by empirical standardized treatment. h) It is not known whether adjuvant corticosteroids are effective in preventing long term complication. i) Surgery may be recommended for MDR-TB. Tamponade or constrictive pericarditis and intestinal obstruction. In conclusion, it is recommended to consider serosal tuberculosis in patients who have unknown mononuclear dominant effusion and prolonged constitutional symptoms. Experimental treatment with first line anti-TB drugs can be started based on possible diagnostic findings.
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Affiliation(s)
- Azadeh Ebrahimzadeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Abdol Sattar Pagheh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Tahoora Mousavi
- Molecular and Cell Biology Research Center (MCBRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Fathi
- Parasitology Department of Medical School, Tarbiat Modares University, Tehran, Iran
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Chopra H, Mohanta YK, Rauta PR, Ahmed R, Mahanta S, Mishra PK, Panda P, Rabaan AA, Alshehri AA, Othman B, Alshahrani MA, Alqahtani AS, AL Basha BA, Dhama K. An Insight into Advances in Developing Nanotechnology Based Therapeutics, Drug Delivery, Diagnostics and Vaccines: Multidimensional Applications in Tuberculosis Disease Management. Pharmaceuticals (Basel) 2023; 16:581. [PMID: 37111338 PMCID: PMC10145450 DOI: 10.3390/ph16040581] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/29/2023] Open
Abstract
Tuberculosis (TB), one of the deadliest contagious diseases, is a major concern worldwide. Long-term treatment, a high pill burden, limited compliance, and strict administration schedules are all variables that contribute to the development of MDR and XDR tuberculosis patients. The rise of multidrug-resistant strains and a scarcity of anti-TB medications pose a threat to TB control in the future. As a result, a strong and effective system is required to overcome technological limitations and improve the efficacy of therapeutic medications, which is still a huge problem for pharmacological technology. Nanotechnology offers an interesting opportunity for accurate identification of mycobacterial strains and improved medication treatment possibilities for tuberculosis. Nano medicine in tuberculosis is an emerging research field that provides the possibility of efficient medication delivery using nanoparticles and a decrease in drug dosages and adverse effects to boost patient compliance with therapy and recovery. Due to their fascinating characteristics, this strategy is useful in overcoming the abnormalities associated with traditional therapy and leads to some optimization of the therapeutic impact. It also decreases the dosing frequency and eliminates the problem of low compliance. To develop modern diagnosis techniques, upgraded treatment, and possible prevention of tuberculosis, the nanoparticle-based tests have demonstrated considerable advances. The literature search was conducted using Scopus, PubMed, Google Scholar, and Elsevier databases only. This article examines the possibility of employing nanotechnology for TB diagnosis, nanotechnology-based medicine delivery systems, and prevention for the successful elimination of TB illnesses.
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Affiliation(s)
- Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India
| | - Yugal Kishore Mohanta
- Nanobiotechnology and Translational Knowledge Laboratory, Department of Applied Biology, School of Biological Sciences, University of Science and Technology Meghalaya (USTM), Techno City, 9th Mile, Ri-Bhoi, Baridua 793101, Meghalaya, India
| | | | - Ramzan Ahmed
- Nanobiotechnology and Translational Knowledge Laboratory, Department of Applied Biology, School of Biological Sciences, University of Science and Technology Meghalaya (USTM), Techno City, 9th Mile, Ri-Bhoi, Baridua 793101, Meghalaya, India
- Department of Physics, Faculty of Science, Kasetsart University, Bangkok 10900, Thailand
| | - Saurov Mahanta
- National Institute of Electronics and Information Technology (NIELIT), Guwahati Centre, Guwahati 781008, Assam, India
| | | | - Paramjot Panda
- School of Biological Sciences, AIPH University, Bhubaneswar 754001, Odisha, India
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Ahmad A. Alshehri
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Basim Othman
- Department of Public Health, Faculty of Applied Medical Sciences, Albaha University, Albaha 65779, Saudi Arabia
| | - Mohammed Abdulrahman Alshahrani
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Ali S. Alqahtani
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Khalid University, Abha 61481, Saudi Arabia
| | - Baneen Ali AL Basha
- Laboratory Department, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India
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Mansour MA, Ahmadi Z, Ali H, Ayad AA. Intracranial tuberculoma masquerading as a brain tumor: A rare presentation in a healthy young adult with no prior history of tuberculosis. IDCases 2023; 31:e01700. [PMID: 36711191 PMCID: PMC9874013 DOI: 10.1016/j.idcr.2023.e01700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Affiliation(s)
- Moustafa A. Mansour
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,Department of Neurology and Neurologic Surgery, Mayo Clinic, Rochester, MN, USA,Division of Neuro-Intensive Care, Dar Al-Fouad Medical Corporation, Cairo, Egypt,Department of Emergency Medicine and Critical Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,Corresponding author at: Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Zarina Ahmadi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hassan Ali
- Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,Division of Neurology and Neurodevelopmental Disorders, Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmad A. Ayad
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Karabella I, Chronopoulos E, Panagiotakopoulos G, Dontas IA. Bone and Joint Tuberculosis in Greece: A Retrospective Study From 2011 to 2019. Cureus 2022; 14:e27033. [PMID: 35989787 PMCID: PMC9386335 DOI: 10.7759/cureus.27033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: Bone and joint tuberculosis (BJTB) represents approximately 2-5% of all tuberculosis (TB) cases and its characteristics are infrequently discussed. The aim of this study was to examine the epidemiology, characteristics, and management of BJTB in Greece. Methods: We conducted retrospective analyses of demographic clinical and treatment data accessed from medical records of patients with BJTB and with pulmonary involvement between 2011 and 2019 from the national TB reference hospital in Greece. Factors associated with treatment outcomes among patients were evaluated. Results: Out of the total 3064 confirmed TB cases during the study period, 54 patients had either BJTB or skeletal TB with pulmonary involvement. The majority of patients were males (81.5%) and the mean age of the patients was 37.81±18.92 years. Out of the total patients, 11 were Greek and 43 were immigrants. Women had a higher probability of experiencing a stable or negative treatment outcome. Also, the patients that received therapy for less than nine months had 16.3 times higher probability of experiencing a stable or negative treatment outcome, compared to those that received therapy for more than 12 months. Conclusions: The study indicated that the sex and the duration of treatment correlated with the treatment outcomes. It is essential to monitor and accurately report treatment outcomes so as to achieve disease control.
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Jabber Benellam YK, Ozkan O, Saadoon Aziz Z. Diagnosis of Mycobacterium tuberculosis using GeneXpert MTB / RIF and TB-LAMP techniques from pulmonary and extra-pulmonary TB patients in Iraq. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.02.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Tuberculosis is considered one globally public health problem, particularly in unindustrialized countries. The disease has an increasing threat to public health, causing high morbidity and mortality rates. So, rapid diagnosis is critical to diminish the death and interfere with transmission. In this study, GeneXpert MTB/RIF and Loop-Mediated Isothermal Amplification (TB-LAMP) assays were utilized for the rapid molecular diagnosis of Mycobacterium tuberculosis bacteria and compared sensitivity and specificity of Mycobacterium tuberculosis bacteria; these tests with acid-fast bacilli staining in pulmonary and extra-pulmonary clinical specimens from Iraqi patients in Baghdad capital. 141 pulmonary and extra-pulmonary samples were collected and tested for tuberculosis detection. Acid-fast bacilli, TB-LAMP and GeneXpert MTB/RIF methods were used to diagnose tuberculosis. Of 141 tuberculosis specimens, 58 were acid-fast bacilli smear-positive, while 90 samples were positive for Mycobacterium tuberculosis by GeneXpert MTB/RIF assay and 78 by TB-LAMP assay. The results reported a high sensitivity rate of GeneXpert MTB/RIF assay compared to the TB-LAMP and bacilli staining method. The sensitivity of GeneXpert was 63.83%, specificity 50%; positive and negative predictive values were 58.36% to 68.96% and 42.73% to 57.27%, respectively. TB-LAMP sensitivity was 55.32%, specificity 50%; positive and negative predictive values were 49.61% to 60.89% and 43.70% to 56.30%, respectively, while the sensitivity of bacilli staining was 41.13%, specificity 50%; positive and negative predictive values were 35.26% to 47.27% and 44.88% to 55.12%, respectively, these values are dependent on disease prevalence. We concluded that the GeneXpert MTB/RIF test is more sensitive and specific than the TB-LAMP and both techniques are more sensitive and specific than the conventional acid-fast staining method for both pulmonary and extra-pulmonary specimens. Despite culture remaining the gold standard for laboratory confirmation of TB, GeneXpert MTB/RIF and TB-LAMP should become standard practice for patients with suspected TB, and all clinicians and public health programs for TB control should have access to molecular testing for TB to shorten diagnosis time.
Keywords. Mycobacterium tuberculosis; Pulmonary TB; Extrapulmonary TB; GeneXpert MTB/RIF; TB-LAMP; A.F.B
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Affiliation(s)
| | - Ozcan Ozkan
- Department of Biology, Faculty of Science, Cankiri Karatekin University, Cankiri, Turkey
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9
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Fallah S, Nasehi M, Etemadinezhad S, Fallah S, Yazdani Charati J. A Five-Year Epidemiological Study of Extra-Pulmonary Tuberculosis and Its Related Risk Factors in Iran. TANAFFOS 2022; 21:221-229. [PMID: 36879733 PMCID: PMC9985131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/10/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Tuberculosis is the most common worldwide cause of death from microbial diseases. Extra-pulmonary tuberculosis accounts for 20% to 25% of all cases. In this study, we used generalized estimation equations to investigate the trend of changes in extra-pulmonary tuberculosis incidence. MATERIALS AND METHODS The recorded data of all patients with extra-pulmonary tuberculosis from 2015 to 2019 in Iran's National Tuberculosis Registration Center were included. The trend of standardized incidence changes in provinces of Iran was calculated and reported linearly. Also, we identified the risk factors related to the extra-pulmonary tuberculosis incidence in five consecutive years using generalized estimating equations. RESULTS We studied the data of 12,537 patients with extra-pulmonary tuberculosis, of whom 50.3% were female. The mean age of the subjects was 43.61±19.88 years. Around 15.4% of all patients had a history of contact with a tuberculosis patient, 43% had a history of hospital stay, and 2.6% had a human immunodeficiency virus infection. Regarding disease types, 25% were lymphatic, 22% were pleural, and 14% were bone. Golestan province had the highest (average of 28.50 ± 8.65 cases), and Fars province had the lowest (average of 3.06 ± 0.75 cases) standardized incidences in these five years. Also, time trend (P < 0.001), employment rate (P = 0.037), and average annual rural income (P = 0.001) had a significant effect on reducing extra-pulmonary tuberculosis incidence. CONCLUSION Extra-pulmonary tuberculosis has a decreasing trend in Iran. Still, Golestan, Sistan and Baluchestan, Hormozgan, and Khuzestan provinces have a higher incidence rate compared to the other provinces.
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Affiliation(s)
- Sahar Fallah
- Faculty of Health, Mazandaran university of Medical Sciences, Sari, Iran
| | - Mahshid Nasehi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Siavash Etemadinezhad
- Department of Occupational Health and Ergonomics, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Simin Fallah
- Department of Linguistics, School of Literature and Human Sciences, Razi University, Kermanshah, Iran
| | - Jamshid Yazdani Charati
- Department of Biostatistics, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Gulati HK, Mawlong M, Agarwal A, Ranee KR. Comparative Evaluation of Clinical, Cytological and Microbiological Profile in Abdominal vs. Cervical Lymph Nodal Tuberculosis with Special Emphasis on Utility of Auramine-O Staining. J Cytol 2022; 38:191-197. [PMID: 35002111 PMCID: PMC8670449 DOI: 10.4103/joc.joc_61_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 04/05/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Context: Extrapulmonary tuberculosis (EPTB) especially abdominal lymph nodal tuberculosis (LNTB) poses a unique diagnostic challenge. The clinical, cytological, and microbiological profiles, especially with respect to the use and role of Auramine –O (AO) stain, are not as well characterized in abdominal LNTB as cervical LNTB and were evaluated in the present comparative study. Subjects and Methods: This study was conducted in the Department of Pathology of a tertiary care hospital in Shillong, Meghalaya in 540 clinical suspected cases of tuberculosis who underwent FNAC. The smears were submitted for Leishman's stain for cytological analysis, along with ZN and Auramine O stain for demonstration of the organism, analyzed, and scored and the results were compared with culture wherever available. The results from abdominal and cervical lymph nodal tuberculosis were compared using Microsoft Excel and SPSS software. Results: Out of 540 cases, most were tuberculosis (266) followed by reactive lymphadenitis (162), malignancy, and acute necrotizing lesion. On comparing, abdominal lymph nodes (n = 163) were more likely to reveal cheesy/purulent material macroscopically, necrotizing lymphadenitis along with ZN stain and Auramine positivity (P < 0.05) while cervical lymph nodes (n = 66) revealed a higher proportion of granulomatous lymphadenitis and culture positivity (P < 0.05). The sensitivity, NPV, and diagnostic accuracy of AO stain (85.9%, 48.0%, and 62.3%) were higher as compared to ZN stain (47.4%, 39.3%, and 51.9%) with culture as the gold standard. The combined sensitivity of Ziehl Neelsen stain and Auramine stain was 92.05%. Conclusion: Cytological and microbiologic features of abdominal LNTB differ from cervical LNTB. Moreover, AO stain increases the smear positivity, is almost twice as sensitive as ZN stain and should be used as an adjunct in cytological material wherever available.
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Affiliation(s)
- Harveen K Gulati
- Department of Pathology, Nazareth Hospital, Laitumkhrah, Shillong, Meghalaya, India
| | - Michael Mawlong
- Department of Microbiology, Nazareth Hospital, Laitumkhrah, Shillong, Meghalaya, India
| | - Arushi Agarwal
- Department of Pathology, Nazareth Hospital, Laitumkhrah, Shillong, Meghalaya, India
| | - Karen R Ranee
- Department of Microbiology, Nazareth Hospital, Laitumkhrah, Shillong, Meghalaya, India
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11
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Conde R, Laires R, Gonçalves LG, Rizvi A, Barroso C, Villar M, Macedo R, Simões MJ, Gaddam S, Lamosa P, Puchades-Carrasco L, Pineda-Lucena A, Patel AB, Mande SC, Barnejee S, Matzapetakis M, Coelho AV. Discovery of serum biomarkers for diagnosis of tuberculosis by NMR metabolomics including cross-validation with a second cohort. Biomed J 2021; 45:654-664. [PMID: 34314900 PMCID: PMC9486122 DOI: 10.1016/j.bj.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/14/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) is a disease with worldwide presence and a major cause of death in several developing countries. Current diagnostic methodologies often lack specificity and sensitivity, whereas a long time is needed to obtain a conclusive result. Methods In an effort to develop better diagnostic methods, this study aimed at the discovery of a biomarker signature for TB diagnosis using a Nuclear Magnetic Resonance based metabolomics approach. In this study, we acquired 1H NMR spectra of blood serum samples of groups of healthy subjects, individuals with latent TB and of patients with pulmonary and extra-pulmonary TB. The resulting data were treated with uni- and multivariate statistical analysis. Results Six metabolites (inosine, hypoxanthine, mannose, asparagine, aspartate and glutamate) were validated by an independent cohort, all of them related with metabolic processes described as associated with TB infection. Conclusion The findings of the study are according with the WHO Target Product Profile recommendations for a triage test to rule-out active TB.
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Affiliation(s)
- R Conde
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - R Laires
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - L G Gonçalves
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - A Rizvi
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, India.
| | - C Barroso
- CDP Almada-Seixal, ARSLVT, Portugal.
| | - M Villar
- CDP Venda Nova, ARSLVT, Portugal.
| | | | | | - S Gaddam
- Department of Immunology, Bhagwan Mahavir Medical Research Center, Hyderabad, India; Department of Genetics, Osmania University, Hyderabad, India.
| | - P Lamosa
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - L Puchades-Carrasco
- Drug Discovery Unit, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - A Pineda-Lucena
- Drug Discovery Unit, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Molecular Therapeutics Program, Centro de Investigación Médica Aplicada, University of Navarra, Pamplona, Spain.
| | - A B Patel
- CSIR- Centre for Cellular Molecular Biology, Hyderabad, India.
| | - S C Mande
- National Centre For Cell Science, Pune, India; Present address: Council of Scientific and Industrial Research, New Delhi, India.
| | - S Barnejee
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, India.
| | - M Matzapetakis
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - A V Coelho
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
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Hegazy WAH, Al Mamari R, Almazroui K, Al Habsi A, Kamona A, AlHarthi H, Al Lawati AI, AlHusaini AH. Retrospective Study of Bone-TB in Oman: 2002-2019. J Epidemiol Glob Health 2021; 11:238-245. [PMID: 33969946 PMCID: PMC8242117 DOI: 10.2991/jegh.k.210420.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: Little information is available about the etiology, pathophysiology, risk factors, and epidemiologic features of Bone Tuberculosis (Bone-TB). In this work, we present the epidemiological data about the Bone-TB in the Sultanate of Oman. Methods: Retrospectively, we identified and assessed those patients who were diagnosed with Bone-TB between January 2002 and December 2019 at Khoula Hospital. The following data were collected: demographics, clinical presentation, anatomical location, diagnosis, and treatment of the Bone-TB. Results: During the study period, 115 cases of Bone-TB were diagnosed. Males were affected more than females (57.4% and 42.6%, respectively). About 30% of Bone-TB cases were primary diagnosed in other organs particularly the lungs and then after disseminated to the bone. However, the Bone-TB was detected in hip, leg, hand, shoulder, and skull bones, the most detected Bone-TB was in spine (66% of cases). After vaccination the Bacillus Calmette–Guérin (BCG) strains were identified in the bones of eight babies. Tubercle bacilli were detected by Acid-Fast Stain (AFS) in 59% of cases, and the rest of cases were confirmed using polymerase chain reaction (PCR) tests. There are two used treatment regimens, with 12.4% relapse. The gastrointestinal tract (GIT) disturbances were the most related side effects. The resistance has been detected to pyrazinamide in six cases, rifampicin in three cases, and isoniazid, streptomycin and kanamycin were detected in one case. Conclusion: The most predominant Bone-TB cases were spine-TB that were mainly disseminated from the lungs. AFS failed to detect tubercle bacilli in 40% of cases. There is no statistical significance in relapse between the used two regimens. The death was predominant among skull-TB cases.
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Affiliation(s)
- Wael A H Hegazy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt.,Department of Pharmacy Practice and pharmaceutical sciences, Pharmacy Program, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - R Al Mamari
- Department of Pharmacy Practice and pharmaceutical sciences, Pharmacy Program, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - K Almazroui
- Pharmacy and Medical Store Department, Clinical Pharmacy Section, Directorate General of Khoula Hospital, Muscat, Sultanate of Oman
| | - A Al Habsi
- Pharmacy and Medical Store Department, Clinical Pharmacy Section, Directorate General of Khoula Hospital, Muscat, Sultanate of Oman
| | - A Kamona
- Department of Pharmacy Practice and pharmaceutical sciences, Pharmacy Program, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - H AlHarthi
- Pharmacy and Medical Store Department, Clinical Pharmacy Section, Directorate General of Khoula Hospital, Muscat, Sultanate of Oman
| | - Areej I Al Lawati
- Pharmacy and Medical Store Department, Directorate General of Royal Hospital, Muscat, Sultanate of Oman
| | - AlZahra H AlHusaini
- Directorate of Drug Store, Injection Section, Directorate General of Medical Supplies, Muscat, Sultanate of Oman
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Immunological Characterization of Proteins Expressed by Genes Located in Mycobacterium tuberculosis-Specific Genomic Regions Encoding the ESAT6-like Proteins. Vaccines (Basel) 2021; 9:vaccines9010027. [PMID: 33430286 PMCID: PMC7825740 DOI: 10.3390/vaccines9010027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 12/14/2022] Open
Abstract
The 6 kDa early secreted antigen target (ESAT6) is a low molecular weight and highly immunogenic protein of Mycobacterium tuberculosis with relevance in the diagnosis of tuberculosis and subunit vaccine development. The gene encoding the ESAT6 protein is located in the M. tuberculosis-specific genomic region known as the region of difference (RD)1. There are 11 M. tuberculosis-specific RDs absent in all of the vaccine strains of BCG, and three of them (RD1, RD7, and RD9) encode immunodominant proteins. Each of these RDs has genes for a pair of ESAT6-like proteins. The immunological characterizations of all the possible proteins encoded by genes in RD1, RD7 and RD9 have shown that, besides ESAT-6 like proteins, several other proteins are major antigens useful for the development of subunit vaccines to substitute or supplement BCG. Furthermore, some of these proteins may replace the purified protein derivative of M. tuberculosis in the specific diagnosis of tuberculosis by using interferon-gamma release assays and/or tuberculin-type skin tests. At least three subunit vaccine candidates containing ESAT6-like proteins as antigen components of multimeric proteins have shown efficacy in phase 1 and phase II clinical trials in humans.
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Mokaddas E, Ahmad S, Eldeen H. Performance Comparison of GeneXpert MTB/RIF and ProbeTec ET Tests for Rapid Molecular Diagnosis of Extrapulmonary Tuberculosis in a Low TB/MDR-TB Incidence Country. Med Princ Pract 2021; 30:277-284. [PMID: 33592621 PMCID: PMC8280443 DOI: 10.1159/000515254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/15/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study evaluated the performance of GeneXpert MTB/RIF (Xpert) and ProbeTec ET (PTec-ET) assays in diagnosing extrapulmonary tuberculosis (EPTB) in Kuwait. MATERIALS AND METHODS We tested nonrespiratory clinical specimens (n = 3,995) collected from 3,995 patients suspected to have EPTB. These included cavitary fluids (n = 2,054), fine-needle aspirate (FNA)/pus/tissue biopsy (n = 1,461), urine (n = 302), cerebrospinal fluid (CSF, n = 118), and others (n = 60). All specimens were processed for acid-fast bacilli (AFB), culture in mycobacteria growth indicator tube 960 system, and nucleic acid detection by Xpert and PTec-ET according to manufacturer's instructions. RESULTS Of 3,995 specimens, 95 were AFB-positive, 403 were culture-positive, and an additional 86 samples had histopathology suggestive of TB. Using culture as reference, the sensitivity and specificity values were 88.33 and 97.3% for Xpert and 72.95 and 97.80% for PTec-ET, respectively. Although performance of both tests was comparable in AFB-positive samples, Xpert detected significantly more cases in culture-positive samples. Among culture-negative samples, Xpert detected 18 more cases including 16 with histopathological evidence of TB. Lowest positivity was detected for both tests in cavitary fluids. Xpert performed better than PTec-ET in culture-positive FNA/pus/tissue biopsy and CSF samples. CONCLUSIONS Although performance of both tests was suboptimal for AFB-negative/culture-positive samples, Xpert performed better than PTec-ET and also detected more cases of AFB-negative/culture-negative/histopathology-positive samples. PTec-ET was positive in 3, while Xpert was positive in all 6 culture-positive CSF specimens for rapid diagnosis of TB meningitis. Xpert was thus superior to PTec-ET or smear microscopy in rapid diagnosis of EPTB.
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Affiliation(s)
- Eiman Mokaddas
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Kuwait National TB Control Laboratory, Shuwaikh, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- *Correspondence to: Suhail Ahmad,
| | - Hanaa Eldeen
- Kuwait National TB Control Laboratory, Shuwaikh, Kuwait
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Serum Inflammation Markers in Tuberculosis. ACTA MEDICA MARTINIANA 2020. [DOI: 10.2478/acm-2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Tuberculosis remains one of the leading infectious cause of death in the world. The goals of screening are to detect active tuberculosis early enough and to identify individuals eligible for preventive therapy to reduce a po tential co-infection by tuberculosis. Plasma/serum screening for selected potential biomarkers could represent a suitable method of tuberculosis diagnosis and treatment outcome. Furthermore, monitoring of tuberculosis treatment is crucial to clinical decision-making and besides the plasmatic concentration of administered antituberculosis drugs, the biomarkers appear to play a significant role in the estimation of the real therapeutical impact.
The current standard remains focused on culture conversion, especially two-month culture status, which has a relatively low sensitivity. Identification of non-sputum-based biomarkers of the treatment respond would be beneficial for individual monitoring of tuberculosis patients.
This mini-review describes several serological/plasmatic markers that can be analyzed by simple immunoassays as ELISA method, e.g. C-reactive protein, soluble intercellular adhesion molecule-1, soluble urokinase plasminogen activator receptor, soluble lymphocyte activation gene-3, granzyme B and soluble tumor necrosis factor receptor one and two as reliable enough as an indicator of successful treatment of tuberculosis.
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Eddabra R, Neffa M. Epidemiological profile among pulmonary and extrapulmonary tuberculosis patients in Laayoune, Morocco. Pan Afr Med J 2020; 37:56. [PMID: 33209183 PMCID: PMC7648485 DOI: 10.11604/pamj.2020.37.56.21111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/31/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction despite major strides in the prevention, diagnosis and management of tuberculosis, the disease continues to be one of the most pressing global health problems, particularly in developing countries. The purpose of the present study was to describe the epidemiological profile among tuberculosis patients in Laayoune, Morocco. Methods a retrospective study was conducted among tuberculosis patients (having extrapulmonary tuberculosis and pulmonary tuberculosis), registered in the diagnosis of tuberculosis and respiratory diseases reference center of Laayoune, between January 2017 and May 2018. Demographic characteristics, clinical presentation of TB and apparent risk factors of the disease were obtained from the medical case records of all patients. Results during the study period, a total of 211 patients (125 males and 86 females) with tuberculosis were enrolled. The majority of cases (93.40%) were newly diagnosed and the segment with the pulmonary tuberculosis was 63.50%. The highest disease burden was found in the ≥15 year age group (92.40%; p=0.022). Men were more frequently affected by pulmonary tuberculosis (70.90%), while extrapulmonary tuberculosis was more commonly detected in women (61%) (p<0.0001). The most common sites of extrapulmonary disease were lymphatic (32.47%), pleural (16.88%) and spinal tuberculosis (15.58%). HIV infection and smoking seem to be the most important risk factors that affect host defense against TB infection. Conclusion the results obtained in tuberculosis patients in Laayoune, Morocco, showed that active tuberculosis was associated with risk factors such as sex, age and smoking.
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Affiliation(s)
- Rkia Eddabra
- Higher Institute of Nurses Professions and Health Techniques of Laayoune, Ministry of Health, Avenue Colonel Major Habbouha Oueld Laâbid, Madinat Al Wahda I, Laayoune, Morocco
| | - Mounsef Neffa
- Laboratory of Bioresources, Biotechnology, Ethnopharmacology and Health, Applied Biochemistry to the Valorization of Bioresources, Faculty of Sciences, Mohamed 1st University, Oujda, Morocco
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Kang W, Yu J, Du J, Yang S, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P, Zhang Y, Dong Y, Yang Z, Mei Z, Deng Q, Wang P, Han W, Wu M, Chen L, Zhao X, Tan L, Li F, Zheng C, Liu H, Li X, A E, Du Y, Liu F, Cui W, Wang Q, Chen X, Han J, Xie Q, Feng Y, Liu W, Tang P, Zhang J, Zheng J, Chen D, Yao X, Ren T, Li Y, Li Y, Wu L, Song Q, Yang M, Zhang J, Liu Y, Guo S, Yan K, Shen X, Lei D, Zhang Y, Yan X, Li L, Tang S. The epidemiology of extrapulmonary tuberculosis in China: A large-scale multi-center observational study. PLoS One 2020; 15:e0237753. [PMID: 32822367 PMCID: PMC7446809 DOI: 10.1371/journal.pone.0237753] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/01/2020] [Indexed: 12/28/2022] Open
Abstract
Tuberculosis (TB) remains a serious global public health problem in the present. TB also affects other sites (extrapulmonary tuberculosis, EPTB), and accounts for a significant proportion of tuberculosis cases worldwide. In order to comprehensively understand epidemiology of EBTB in China, and improve early diagnosis and treatment, we conducted a large-scale multi-center observational study to assess the demographic data and the prevalence of common EPTB inpatients, and further evaluate the prevalence of EPTB concurrent with Pulmonary tuberculosis (PTB) and the associations between multiple EPTB types and gender-age group in China. All consecutive age≥15yr inpatients with a confirmed diagnosis of EPTB during the period from January 2011 to December 2017 were included in the study. The descriptive statistical analysis included median and quartile measurements for continuous variables, and frequencies and proportions with 95% confidence intervals (CIs) for categorical variables. Multinomial logistic regression analysis was used to compare the association of multiple EPTB types between age group and gender. The results showed that the proportion of 15–24 years and 25–34 years in EPTB inpatients were the most and the ratio of male: female was 1.51. Approximately 70% of EPTB inpatients were concurrent with PTB or other types of EPTB. The most common of EPTB was tuberculous pleurisy (50.15%), followed by bronchial tuberculosis (14.96%), tuberculous lymphadenitis of the neck (7.24%), tuberculous meningitis (7.23%), etc. It was found that many EPTB inpatients concurrent with PTB. The highest prevalence of EPTB concurrent with PTB was pharyngeal/laryngeal tuberculosis (91.31%), followed by bronchial tuberculosis (89.52%), tuberculosis of hilar lymph nodes (79.52%), tuberculosis of mediastinal lymph nodes (79.13%), intestinal tuberculosis (72.04%), tuberculous pleurisy (65.31%) and tuberculous meningitis (62.64%), etc. The results from EPTB concurrent with PTB suggested that females EPTB inpatients were less likely to be at higher risk of concurrent PTB (aOR = 0.819, 95%CI:0.803–0.835) after adjusted by age. As age increasing, the trend risk of concurrent PTB decreased (aOR = 0.994, 95%CI: 0.989–0.999) after adjusted by gender. Our study demonstrated that the common EPTB were tuberculous pleurisy, bronchial tuberculosis, tuberculous lymphadenitis of the neck, tuberculous meningitis, etc. A majority of patients with pharyngeal/laryngeal tuberculosis, bronchial tuberculosis, tuberculosis of hilar/mediastinal lymph nodes, intestinal tuberculosis, tuberculous pleurisy, tuberculous meningitis, etc. were concurrent with PTB. Female EPTB inpatients were less likely to be at higher risk of concurrent PTB, and as age increasing, the trend risk of concurrent PTB decreased. The clinicians should be alert to the presence of concurrent tuberculosis in EPTB, and all suspected cases of EPTB should be assessed for concomitant PTB to determine whether the case is infectious and to help for early diagnosis and treatment.
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Affiliation(s)
- Wanli Kang
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Jiajia Yu
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Jian Du
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Song Yang
- Chongqing Public Health Medical Center, Chongqing, China
| | | | - Jianxiong Liu
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Jinshan Ma
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Mingwu Li
- The Third People’s Hospital of Kunming, Kunming City, Yunnan Province, China
| | - Jingmin Qin
- Shandong provincial Chest Hospital, Jinan, Shandong, China
| | - Wei Shu
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
| | - Peilan Zong
- Jiangxi Chest (third people) Hospital, Nanchang City, Jiangxi Province, China
| | - Yi Zhang
- Chang Chun Infectious Diseases Hospital, Changchun City, Jilin Province, China
| | - Yongkang Dong
- Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, China
| | - Zhiyi Yang
- Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | | | - Qunyi Deng
- Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Pu Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenge Han
- Weifang NO.2 People’s Hospital, Shandong Province, China
| | - Meiying Wu
- The Fifth People’s Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Ling Chen
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Xinguo Zhao
- The Fifth People’s Hospital of Wuxi, Wuxi, China
| | - Lei Tan
- TB Hospital of Siping City, Siping City, Jilin Province, China
| | - Fujian Li
- Baoding Hospital for Infectious Disease, Baoding City, Hebei Province, China
| | - Chao Zheng
- The First Affiliated of XiaMen University, Xiamen City, Fujian Province, China
| | | | - Xinjie Li
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Ertai A
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Yingrong Du
- The Third People’s Hospital of Kunming, Kunming City, Yunnan Province, China
| | - Fenglin Liu
- Shandong provincial Chest Hospital, Jinan, Shandong, China
| | - Wenyu Cui
- Chang Chun Infectious Diseases Hospital, Changchun City, Jilin Province, China
| | - Quanhong Wang
- Taiyuan Fourth People’s Hospital, Taiyuan City, Shanxi Province, China
| | | | | | - Qingyao Xie
- Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Yanmei Feng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenyu Liu
- Weifang NO.2 People’s Hospital, Shandong Province, China
| | - Peijun Tang
- The Fifth People’s Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Jianyong Zhang
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Jian Zheng
- The Fifth People’s Hospital of Wuxi, Wuxi, China
| | - Dawei Chen
- Baoding Hospital for Infectious Disease, Baoding City, Hebei Province, China
| | - Xiangyang Yao
- The First Affiliated of XiaMen University, Xiamen City, Fujian Province, China
| | - Tong Ren
- Shenyang chest Hospital, Shenyang, China
| | - Yan Li
- Guang Zhou Chest Hospital, Guangzhou, Guangdong, China
| | - Yuanyuan Li
- Chest Hospital of Xinjiang, Urumqi, Xinjiang, China
| | - Lei Wu
- The Third People’s Hospital of Kunming, Kunming City, Yunnan Province, China
| | - Qiang Song
- Shandong provincial Chest Hospital, Jinan, Shandong, China
| | - Mei Yang
- Chongqing Public Health Medical Center, Chongqing, China
| | - Jian Zhang
- Chang Chun Infectious Diseases Hospital, Changchun City, Jilin Province, China
| | | | - Shuliang Guo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Yan
- Weifang NO.2 People’s Hospital, Shandong Province, China
| | - Xinghua Shen
- The Fifth People’s Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Dan Lei
- Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Yanli Zhang
- Baoding Hospital for Infectious Disease, Baoding City, Hebei Province, China
| | - Xiaofeng Yan
- Chongqing Public Health Medical Center, Chongqing, China
- * E-mail: (ST); (LL); (XY)
| | - Liang Li
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
- * E-mail: (ST); (LL); (XY)
| | - Shenjie Tang
- Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, China
- * E-mail: (ST); (LL); (XY)
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Khan AH, Sulaiman SAS, Laghari M, Hassali MA, Muttalif AR, Bhatti Z, Ming LC, Talpur BA. Treatment outcomes and risk factors of extra-pulmonary tuberculosis in patients with co-morbidities. BMC Infect Dis 2019; 19:691. [PMID: 31382889 PMCID: PMC6683549 DOI: 10.1186/s12879-019-4312-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/24/2019] [Indexed: 01/06/2023] Open
Abstract
Background Extra-pulmonary tuberculosis (EPTB) represents about 14% of all cases of tuberculosis (TB) in Malaysia. The aims of the study include evaluation of socio-demographic factors, clinical manifestations, co-morbidities among patients with EPTB and their treatment outcomes. Methods A retrospective study was conducted to recognize the epidemiology facts of EPTB. Individual data for EPTB patients were collected from TB registers, laboratory TB registers, treatment cards and TB medical personal files into a standardized study questionnaire. Crude (COR) and adjusted odds ratios (AOR) and 95% confidence intervals (CI) were determined to assess the risk factors for EPTB and unsuccessful treatment outcomes. Results There were 1222 EPTB patients presenting 13.1% of all TB cases during 2006–2008. Pleural effusion and lymph node TB were the most frequent types and accounted for 45.1% of all EPTB cases among study participants. Treatment success rate was 67.6%. The best treatment completion rates were found in children ≤15 years (0.478 [0.231–1.028]; p = 0.05). On multivariate analysis, age group 56–65 years (1.658 [1.157–2.376]; p = 0.006), relapse cases (7.078 [1.585–31.613]; p = 0.010), EPTB-DM (1.773 [1.165–2.698]; p = 0.008), patients with no formal (2.266 [1.254–4.095]; p = 0.001) and secondary level of education (1.889 [1.085–3.288]; p = 0.025) were recorded as statistically positive significant risk factors for unsuccessful treatment outcomes. Patients at the risk of EPTB were more likely to be females (1.524 [1.311–1.746]; p < 0.001), Malays (1.251 [1.056–1.482]; p = 0.010) and Indians (1.450 [1.142–1.842]; p = 0.002), TB-HIV (3.215 [2.347–4.405]; p < 0.001), EPDM-HIV (4.361 [1.657–11.474]; p = 0.003), EPTB-HIV-HEP (4.083 [2.785–5.987]; p < 0.001), those living in urban areas (1.272 [1.109–1.459]; p = 0.001) and no formal education (1.361 [1.018–1.820]; p = 0.037). Conclusion The findings of this study extend the knowledge of EPTB epidemiology and highlight the need for improved EPTB detection in Malaysia, especially in subpopulations with high risk for EPTB and unsuccessful treatment outcomes.
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Affiliation(s)
- Amer Hayat Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.
| | - Syed Azhar Syed Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Madeeha Laghari
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.,Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Abdul Razak Muttalif
- Department of Respiratory Medicine, Penang General Hospital, George Town, Penang, Malaysia
| | - Zohra Bhatti
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Long Chiau Ming
- School of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia.,Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Bandeh Ali Talpur
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
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Talhar SS, Ambulkar PS, Sontakke BR, Waghmare PJ, Shende MR, Pal AK, Narang P. Oxidative stress and its impact on mitochondrial DNA in pulmonary tuberculosis patients- a pilot study. ACTA ACUST UNITED AC 2019; 66:227-233. [DOI: 10.1016/j.ijtb.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/07/2019] [Accepted: 03/18/2019] [Indexed: 01/18/2023]
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Salami MA, Sanusi AA, Adegboye VO. Current Indications and Outcome of Pulmonary Resections for Tuberculosis Complications in Ibadan, Nigeria. Med Princ Pract 2018; 27:80-85. [PMID: 29156450 PMCID: PMC5968272 DOI: 10.1159/000485382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/16/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To review the current indications and outcome of pulmonary resections for tuberculosis (TB) at the Cardiothoracic Surgery Unit of the University College Hospital, Ibadan, Nigeria. SUBJECTS AND METHODS A retrospective case series review of patients who had lung resections from January 2014 to January 2017 was performed. Data obtained from medical records included demographics, presenting symptoms, indication for surgery, preoperative evaluation and preparation, operative procedure, postoperative complications, and follow-up. The presence of TB in the patients was confirmed by detecting pathological changes suggestive of TB and/or past history of pulmonary TB associated with its anatomical complications such as cavitation and bronchiectasis. Data were analysed using descriptive statistics. RESULTS Ten patients had pulmonary resections during this study period. The median age was 33.5 years (range: 3-50). The indication for lung resection was massive or persistent haemoptysis, and 2 patients also had aspergilloma. Six patients (60%) had lobectomy, 1 had a bilobectomy, and the remaining 3 had pneumonectomy. Complications included partial wound dehiscence in 2 patients, 1 of whom also had postoperative empyema thoracis. One patient died immediately due to haemorrhage. Follow-up ranged from 6 to 37 months. CONCLUSION This study showed that the factors for a good outcome in patients presenting with massive or recurrent haemoptysis from TB complications were initial stabilization and multidisciplinary care. Hence, improved awareness of high-standard care to encourage inclusion of patients with TB complications in the surgical care protocol as part of national control programmes is recommended.
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Affiliation(s)
- Mudasiru A. Salami
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Ibadan, Ibadan, Nigeria
- *Dr. Mudasiru A. Salami, Department of Surgery, University College Hospital, College of Medicine, University of Ibadan, PO Box 29225, Secretariat Post Office, Ibadan 200212 (Nigeria), E-Mail
| | - Arinola A. Sanusi
- Department of Anaesthesia, University College Hospital, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Victor O. Adegboye
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Ibadan, Ibadan, Nigeria
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Khosravi AD, Alami A, Meghdadi H, Hosseini AA. Identification of Mycobacterium tuberculosis in Clinical Specimens of Patients Suspected of Having Extrapulmonary Tuberculosis by Application of Nested PCR on Five Different Genes. Front Cell Infect Microbiol 2017; 7:3. [PMID: 28144587 PMCID: PMC5239771 DOI: 10.3389/fcimb.2017.00003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/03/2017] [Indexed: 01/05/2023] Open
Abstract
Definitive and rapid diagnosis of extrapulmonary tuberculosis (EPTB) is challenging since conventional techniques have limitations due to the paucibacillary nature of the disease. To increase the sensitivity of detection of Mycobacterium tuberculosis (MTB) in EPTB specimens, we performed a nested PCR assay targeting several genes of MTB on EPTB specimens. A total of 100 clinical specimens from suspected cases of EPTB were processed. Standard staining for acid fast bacilli (AFB) was performed as the preliminary screening test. Extracted DNAs from specimens were subjected to Nested PCR technique for the detection of five different MTB target genes of IS6110, IS1081, hsp65kd, mbp64, and mtp40. On performing AFB staining, only 13% of specimens were positive, of which ascites fluid (33.3%), followed by pleural effusion (30.8%) showed the greatest AFB positivity rate. We demonstrated slight improvement in yields in lymph node which comprised the majority of specimens in this study, by employing PCR targeted to IS6110- and hsp65-genes in comparison to AFB staining. However, the yields in ascites fluid and pleural effusion were not substantially improved by PCR, but those from bone and wound were, as in nested PCR employing either gene, the same positivity rate were obtained for ascites fluid (33.3%), while for pleural effusion specimens only IS1081 based PCR showed identical positivity rate with AFB stain (30.8%). The results for bone and wound specimens, however, demonstrated an improved yield mainly by employing IS1081 gene. Here, we report higher detection rate of EPTB in clinical specimens using five different targeted MTB genes. This nested PCR approach facilitates the comparison and the selection of the most frequently detected genes. Of course this study demonstrated the priority of IS1081 followed by mtp40 and IS6110, among the five tested genes and indicates the effectiveness of any of the three genes in the design of an efficient nested-PCR test that facilitates an early diagnosis of paucibacillary EPTB cases, which are difficult to diagnose with the available standard.
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Affiliation(s)
- Azar D Khosravi
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran; Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Ameneh Alami
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences Ahvaz, Iran
| | - Hossein Meghdadi
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences Ahvaz, Iran
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Sieniawska E, Swatko-Ossor M, Sawicki R, Skalicka-Woźniak K, Ginalska G. Natural Terpenes Influence the Activity of Antibiotics against Isolated Mycobacterium tuberculosis. Med Princ Pract 2017; 26:108-112. [PMID: 27883995 PMCID: PMC5588368 DOI: 10.1159/000454680] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In this study, we aimed to describe the influence of natural terpenes on the antimycobacterial activity of first-line tuberculostatic drugs against isolated Mycobacterium tuberculosis. MATERIALS AND METHODS The natural terpenes used in this study were R-limonene, S-limonene, myrcene, sabinene, α-pinene, and β-elemene. The values of the minimum inhibitory concentration (MIC) for these terpenes, as well as for combinations of terpenes with tuberculostatic antibiotics (ethambutol, isoniazid, and rifampicin), were determined using a tube log2 dilution method in the range of 125-0.059 µg/mL. RESULTS S-limonene had a strong synergistic effect with all tested antibiotics (MIC decreased from 16 to 0.475 µg/mL for ethambutol, from 16 to 0.237 µg/mL for rifampicin, and from 32 to 0.475 µg/mL for isoniazid). Combinations of myrcene, R-limonene, β-elemene, and sabinene with tuberculostatic antibiotics resulted in a decreased MIC of the antibiotics (from 3.9 to 0.475 µg/mL for ethambutol, from 15 to 0.475 µg/mL for isoniazid, and from 0.475 to 0.237 µg/mL for rifampicin) while combinations of α-pinene with ethambutol and isoniazid resulted in increased MIC values (from 16 to 125 µg/mL for ethambutol, and from 32 to 125 µg/mL for isoniazid). Rifampicin had a synergistic increase in activity with all the tested compounds. CONCLUSIONS Our study showed that terpenes enhance the activity of tuberculostatic antibiotics.
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Affiliation(s)
- Elwira Sieniawska
- Department of Pharmacognosy with Medicinal Plant Unit, Medical University of Lublin, Lublin, Poland
- *Elwira Sieniawska, Department of Pharmacognosy with Medicinal Plant Unit, Medical University of Lublin, Chodzki 1, PL-20-093 Lublin (Poland), E-Mail
| | - Marta Swatko-Ossor
- Department of Biochemistry and Biotechnology, Medical University of Lublin, Lublin, Poland
| | - Rafał Sawicki
- Department of Biochemistry and Biotechnology, Medical University of Lublin, Lublin, Poland
| | | | - Grazyna Ginalska
- Department of Biochemistry and Biotechnology, Medical University of Lublin, Lublin, Poland
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Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases. Ann Clin Microbiol Antimicrob 2015; 14:34. [PMID: 26104066 PMCID: PMC4504222 DOI: 10.1186/s12941-015-0092-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis is a disease that can involve every organ system. While pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis (EPT) is also an important clinical problem. The current study aimed to outline and compare the demographic and clinical features of pulmonary and extrapulmonary tuberculosis cases in adults. METHODS Medical records of 411 patients (190 women, 221 men) treated between January 2010 and July 2014 in provincial tuberculosis control dispensary was retrospectively reviewed. Demographic and clinical characteristics were compared for pulmonary and extrapulmonary tuberculosis cases. RESULTS Of these 411 cases, 208 (50.6%) had pulmonary tuberculosis (PTB) and 203 were diagnosed with extrapulmonary tuberculosis (EPTB) (49.4%). The average ages for PTB and EPTB groups were 33.00-27.00 and 31.00-29.75, respectively (p = 0.513). Men were more frequently affected by PTB (59.6%), while EPTB was more commonly detected in women (52.2%) (p = 0.016). Main diagnostic modalities for PTB were sputum/smear analyses (72.7%), clinical-radiological data (21.7%) and biopsy (6.1%); while biopsy (71.5%), sputum/fluid analysis (18.8%) and clinical-radiological data (4.9%) were used for confirming EPTB (p < 0.0019). The most common sites of EPTB involvement were lymph nodes (39.4%), followed by pleura (23.6%), peritoneum (9.9%) and bone (7.4%). CONCLUSIONS Extrapulmonary involvement of tuberculosis is common and females are more likely to be affected. Increased clinical awareness is important since atypical presentations of the disease may constitute diagnostic and therapeutic challenges.
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