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Heffernan C, Egedahl ML, Barrie J, Winter C, Armstrong G, Doroshenko A, Tyrrell G, Paulsen C, Lau A, Long R. The prevalence, risk factors, and public health consequences of peripheral lymph node-associated clinical and subclinical pulmonary tuberculosis. Int J Infect Dis 2023; 129:165-174. [PMID: 36736990 DOI: 10.1016/j.ijid.2023.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Relatively little is known about the prevalence, risk factors, and public health consequences of peripheral lymph node (PLN)-associated pulmonary tuberculosis (PTB). METHODS We developed a 10-year (2010-2019) population-based cohort of PLNTB patients in Canada. We used systematically collected primary source data and expert reader chest radiograph interpretations in a multivariable logistic regression to determine associations between sputum culture positivity and demographic, clinical, and radiographic features. Public health risks were estimated among contacts of PLNTB patients. RESULTS There were 306 patients with PLNTB, among whom 283 (92.5%) were 15-64 years of age, 159 (52.0%) were female, and 293 (95.8%) were foreign-born. Respiratory symptoms were present in 21.6%, and abnormal chest radiograph in 23.2%. Sputum culture positivity ranged from 12.9% in patients with no symptoms and normal lung parenchyma to 66.7% in patients with both. Respiratory symptoms, abnormal lung parenchyma, and HIV-coinfection (borderline) were independent predictors of sputum culture positivity (odds ratio [OR] 2.24 [95% confidence interval [CI] 1.15-4.39], P = 0.01, OR 4.78 [95% CI 2.41-9.48], P < 0.001, and OR 2.54 [95% CI 0.99-6.52], P = 0.05), respectively. Among contacts of sputum culture-positive PLNTB patients, one secondary case and 16 new infections were identified. CONCLUSION Isochronous PTB is common in PLNTB patients. Routine screening of PLNTB patients for PTB is strongly recommended.
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Affiliation(s)
- Courtney Heffernan
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Lou Egedahl
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - James Barrie
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Winter
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Armstrong
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander Doroshenko
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory Tyrrell
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Paulsen
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Angela Lau
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Long
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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2
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Le V, Pascopella L, Westenhouse J, Barry P. A Cross-sectional Study of Patients With Extrapulmonary Tuberculosis and Normal Chest Radiographs - What Characteristics Were Associated With Sputum Culture Positivity? Clin Infect Dis 2022; 75:2113-2118. [PMID: 35514293 DOI: 10.1093/cid/ciac338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Recognizing pulmonary involvement in tuberculosis (TB) patients is necessary to prevent TB transmission. We describe frequency and characteristics of patients with extrapulmonary TB (EPTB), normal chest radiographs, and positive sputum culture. METHODS We analyzed data of patients ≥15 years of age with EPTB reported to the California TB registry during 2011-2017 with cultured sputum and normal chest radiographs using generalized linear modeling to estimate prevalence ratios associated with positive sputum culture. Demographic, behavioral, clinical characteristics, and testing were compared for patients with positive and negative sputum culture. RESULTS Of 1635 patients with EPTB and normal chest radiographs, 937 (57%) had sputum culture performed, and 127 (13%) patients had positive results for Mycobacterium tuberculosis complex. Patients with positive results were more likely to: be male, experience homelessness, use substances, have HIV, and have >1 disease site. Among 85 patients with HIV co-infection, 54% had positive culture results compared with 9.5% among 852 patients without HIV co-infection. Patients with EPTB in more than 1 site were also more likely to have a positive sputum culture. CONCLUSIONS Culturing sputum from patients with EPTB identified pulmonary cases not detected by chest radiograph, particularly among patients with HIV or >1 disease site.
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Affiliation(s)
- Victoria Le
- Tuberculosis Control Branch, Division of Communicable Disease Control, California Department of Public Health, Center for Infectious Diseases, Richmond, California, USA
| | - Lisa Pascopella
- Tuberculosis Control Branch, Division of Communicable Disease Control, California Department of Public Health, Center for Infectious Diseases, Richmond, California, USA
| | - Janice Westenhouse
- Tuberculosis Control Branch, Division of Communicable Disease Control, California Department of Public Health, Center for Infectious Diseases, Richmond, California, USA
| | - Pennan Barry
- Tuberculosis Control Branch, Division of Communicable Disease Control, California Department of Public Health, Center for Infectious Diseases, Richmond, California, USA
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3
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Shivakumar SVBY, Padmapriyadarsini C, Chavan A, Paradkar M, Shrinivasa BM, Gupte A, Dhanasekaran K, Thomas B, Suryavanshi N, Dolla CK, Selvaraju S, Kinikar A, Gaikwad S, Kohli R, Sivaramakrishnan GN, Pradhan N, Hanna LE, Kulkarni V, DeLuca A, Cox SR, Murali L, Thiruvengadam K, Raskar S, Ramachandran G, Golub JE, Gupte N, Mave V, Swaminathan S, Gupta A, Bollinger RC. Concomitant pulmonary disease is common among patients with extrapulmonary TB. Int J Tuberc Lung Dis 2022; 26:341-347. [PMID: 35351239 PMCID: PMC8982647 DOI: 10.5588/ijtld.21.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND : Microbiologic screening of extrapulmonary TB (EPTB) patients could inform recommendations for aerosol precautions and close contact prophylaxis. However, this is currently not routinely recommended in India. Therefore, we estimated the proportion of Indian patients with EPTB with microbiologic evidence of pulmonary TB (PTB). METHODS : We characterized baseline clinical, radiological and sputum microbiologic data of 885 adult and pediatric TB patients in Chennai and Pune, India, between March 2014 and November 2018. RESULTS : Of 277 patients with EPTB, enhanced screening led to the identification of 124 (45%) with concomitant PTB, including 53 (19%) who reported a cough >2 weeks; 158 (63%) had an abnormal CXR and 51 (19%) had a positive sputum for TB. Of 70 participants with a normal CXR and without any cough, 14 (20%) had a positive sputum for TB. Overall, the incremental yield of enhanced screening of patients with EPTB to identify concomitant PTB disease was 14% (95% CI 12–16). CONCLUSIONS : A high proportion of patients classified as EPTB in India have concomitant PTB. Our results support the need for improved symptom and CXR screening, and recommends routine sputum TB microbiology screening of all Indian patients with EPTB.
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Affiliation(s)
| | - C Padmapriyadarsini
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - A Chavan
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - M Paradkar
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - B M Shrinivasa
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - A Gupte
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - K Dhanasekaran
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - B Thomas
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - N Suryavanshi
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - C K Dolla
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - S Selvaraju
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - A Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - S Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - R Kohli
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - G N Sivaramakrishnan
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - N Pradhan
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - L E Hanna
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - V Kulkarni
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A DeLuca
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S R Cox
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - L Murali
- District Tuberculosis Office, Thiruvallur, India
| | - K Thiruvengadam
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - S Raskar
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - G Ramachandran
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - J E Golub
- Johns Hopkins School of Medicine, Baltimore, MD, USA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Gupte
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - V Mave
- Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - A Gupta
- Johns Hopkins School of Medicine, Baltimore, MD, USA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - R C Bollinger
- Johns Hopkins School of Medicine, Baltimore, MD, USA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Suárez I, Rohr S, Stecher M, Lehmann C, Winter S, Jung N, Priesner V, Berger M, Wyen C, Augustin M, Malin JJ, Fischer J, Horn C, Neuhann F, Püsken M, Plum G, Fätkenheuer G, Rybniker J. Plasma interferon-γ-inducible protein 10 (IP-10) levels correlate with disease severity and paradoxical reactions in extrapulmonary tuberculosis. Infection 2020; 49:437-445. [PMID: 33140838 PMCID: PMC7605464 DOI: 10.1007/s15010-020-01541-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND With 1.5 million deaths worldwide in 2018, tuberculosis (TB) remains a major global public health problem. While pulmonary TB (PTB) is the most common manifestation, the proportion of extrapulmonary TB (EPTB) is increasing in low-burden countries. EPTB is a heterogeneous disease entity posing diagnostic and management challenges due to the lack of reliable biomarkers. In this study, we prospectively evaluated clinical data and treatment response which were correlated with different biomarkers. METHODS The study was conducted at the University Hospital of Cologne. 20 patients with EPTB were enrolled. We analyzed plasma interferon-γ-inducible protein 10 (IP-10) levels in plasma by ELISA for up to 12 months of treatment. In addition, the QuantiFERON®-TB Gold Plus (QFT® Plus) test was performed during the course of treatment. Clinical data were assessed prospectively and correlated with QFT® Plus and IP-10 levels. RESULTS Plasma IP-10 levels were found to be significantly increased (p < 0.001) in patients with extensive disease compared to patients with limited disease (cervical lymph node TB) or healthy controls. In patients with clinically confirmed paradoxical reaction (PR), a further increase of IP-10 was noted. IFN-γ measured by the QFT® Plus test did not decrease significantly during the course of treatment. Of note, in four EPTB patients (20%) without radiographic pulmonary involvement, sputum culture was positive for Mycobacterium tuberculosis. CONCLUSION Our data demonstrate that IP-10 may be a valuable biomarker for estimation of disease severity in EPTB and monitoring of the disease course in extensive forms. However, IP-10 may be less suitable for diagnosis and monitoring of EPTB patients with limited disease. The QFT® Plus test does not appear to be a suitable marker for therapy monitoring. Sputum should be examined in EPTB patients even in case of normal diagnostic imaging of the chest.
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Affiliation(s)
- Isabelle Suárez
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Samuel Rohr
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Melanie Stecher
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Clara Lehmann
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Sandra Winter
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Norma Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Vanessa Priesner
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Melanie Berger
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, Kliniken Der Stadt Köln GmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Christoph Wyen
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Praxis Am Ebertplatz, Cologne, Germany
| | - Max Augustin
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Jakob J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Julia Fischer
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Carola Horn
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Florian Neuhann
- Levy Mwanawasa Medical University (LMMU), Lusaka, Zambia.,Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany.,Municipal Health Authority Cologne, Cologne, Germany
| | - Michael Püsken
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Jan Rybniker
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. .,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany. .,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
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5
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Liu Y, Jiang Z, Chen H, Jing H, Cao X, Coia JE, Song Z. Description of demographic and clinical characteristics of extrapulmonary tuberculosis in Shandong, China. Hippokratia 2020; 24:27-32. [PMID: 33364736 PMCID: PMC7733363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND According to the clinical manifestation, tuberculosis (TB) is divided into pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB). The incidence rate of EPTB has increased in many countries. The demographic and clinical characteristics of EPTB in China remain still unclear. MATERIALS AND METHODS We retrospectively analyzed the medical records of 5,624 hospitalized patients with positive M. tuberculosis culture between January 2008 and June 2013 in Shandong province. We investigated the epidemiological, demographic, and clinical characteristics of patients with EPTB. RESULTS Among 5,624 hospitalized TB patients with positive M. tuberculosis culture, 4,277 (76.05 %) had PTB, 618 (10.99 %) had EPTB, and 729 (12.96 %) had both PTB and EPTB. The proportion of EPTB increased significantly from 6.97 % in 2008 to 19.98 % in 2012 (p <0.001). The most frequent sites or foci of EPTB were pleura (63.27 %), followed by bone/joint (13.75 %), and lymph nodes (8.9 %). The mean duration of treatment for pleural TB was eight months and for EPTB in the other foci was more than 15 months. CONCLUSION The proportion of EPTB in Shandong province has significantly increased. Clinicians need to be aware of the trend and remain vigilant against EPTB. EPTB requires prolonged treatment, and clinical supervision should be strengthened to prevent drug resistance. HIPPOKRATIA 2020, 24(1): 27-32.
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Affiliation(s)
- Y Liu
- Department of Radiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Z Jiang
- Department of Intensive Care Unit, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - H Chen
- Department of Intensive Care Unit, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - H Jing
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - X Cao
- Department of Cardiology, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - J E Coia
- Department of Clinical Microbiology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Z Song
- Department of Clinical Microbiology, Hospital of Southwest Jutland, Esbjerg, Denmark
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Al-Bishri J, Masoodi I, Adnan M, Tariq M, Abdullah H, Abdulgoni T, Bander G, Altalhi M. Population dynamics and tuberculosis: a cross sectional study of an overlooked disease in Saudi Arabia. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2014; 12:Doc02. [PMID: 24454274 PMCID: PMC3895866 DOI: 10.3205/000187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 11/30/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND International travel, migration and human population movements facilitate the spread of tuberculosis (TB). OBJECTIVE To study the impact of poorly screened expatriates working in Saudi Arabia on the local incidence of TBs. PATIENTS AND METHODS This cross sectional study was carried out in the Chest Disease Hospital, Taif. All confirmed cases of TB from June 2009 to May 2010 admitted to the hospital were enrolled. Inclusion criteria were diagnosed cases of TB (pulmonary & extra-pulmonary) in patients between the ages of 14 to 65 years. Patients with HIV and coexistent malignancies were excluded. The age, gender and ethnic group of each patient was recorded, and patients were divided into two groups. Of the two groups, Group A consisted of Taif residents and group B of patients referred from other cities in the country. RESULTS Of the 686 cases studied, 370 (54%) were Saudi nationals (Group A = 80 & Group B = 290) and 316 (46%) cases were from other countries. Males outnumbered females and most of the patients were aged 20 to 29 years. The number of cases from the areas close to the pilgrimage sites, i.e. Makah (233) and Jeddah (275), outnumbered those in Taif (110). CONCLUSIONS Our study identifies an increased prevalence of TB cases in areas close to the pilgrimage (Group B). The higher proportion of non-Saudi TB patients in group B is most likely explained by the higher number of poorly screened illegal expatriates in the region.
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Affiliation(s)
- Jamal Al-Bishri
- Dept. of Medicine, College of Medicine, Taif University, Saudi Arabia
| | - Ibrahim Masoodi
- Dept. of Medicine, College of Medicine, Taif University, Saudi Arabia
| | - Mubarki Adnan
- Dept. of Medicine, College of Medicine, Taif University, Saudi Arabia
| | - Malik Tariq
- Dept. of Medicine, Chest Disease Hospital, Taif, Saudi Arabia
| | - Harthi Abdullah
- Dept. of Medicine, Chest Disease Hospital, Taif, Saudi Arabia
| | | | - Guraibi Bander
- Dept. of Medicine, College of Medicine, Taif University, Saudi Arabia
| | - Mansoor Altalhi
- Dept. of Medicine, Chest Disease Hospital, Taif, Saudi Arabia
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7
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Shanmuganathan A, R S, G T, D S, C S, James B. Determination of Sites Involved, HIV Co-Infection & Utility of Diagnostic Modalities in EPTB. J Clin Diagn Res 2013; 7:1644-6. [PMID: 24086863 DOI: 10.7860/jcdr/2013/6363.3301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/04/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tuberculosis remains a major global public health problem and an on-going epidemic. Though the chief objectives of the Revised National Tuberculosis Control Programme (RNTCP) in detecting and curing the infectious pulmonary cases is well taken, there has been a steady rise in the number of Extra Pulmonary Tuberculosis (EPTB) cases as documented in several studies. EPTB which usually constitutes around 15%-20% of the total TB cases is now being increasingly reported due to a combination of better diagnostic facilities, and the HIV pandemic. Though several studies have shown increasing prevalence of EPTB, only few studies are available, especially in the Indian scenario, that study the pattern and risk factors. Hence, this retrospective observational study was undertaken to determine the sites of the involvement, HIV co-infection and usefulness of various diagnostic modalities in EPTB affecting patients attending a medical college DOTS clinic. MATERIAL AND METHODS One hundred ten EPTB patients referred to the DOTS clinics of the TB & Chest department from the period Dec 2010- Mar 2012 were included in the study. The diagnosis of EPTB was established by combined clinical, microbiological, histopathological &/or imaging modalities. Their medical records were assessed to determine the age distribution, gender and anatomical sites of involvement. The presence of co-morbid conditions like smoking history, alcoholism, diabetic and HIV status were noted. BCG status and Mantoux test readings were recorded. The different diagnostic tests used in confirming EPTB at different sites were recorded. Chest x-ray was analysed for all patients to assess coexisting pulmonary involvement. All patients were followed to assess the outcome of treatment. RESULTS The mean age of patients was 34.4. The male to female ratio was 58:52 showing a slight male predominance. The most common site of involvement was lymph node followed by pleural effusion and abdominal TB. The prevalence of lymph node TB was noted to be higher in female patients as compared to other sites of EPTB. Mantoux test was positive in 57 (51.8%) patients. HIV co-infection was noted in only 3 (2.7%) patients. Concomitant pulmonary involvement was seen in 19 (17.3%) patients. CONCLUSIONS Lymph node was the most common site involvement showing a significant female preponderance followed by pleural effusion and abdominal TB. The rates of HIV co-infection and diabetes mellitus were 2.7% and 20% respectively. The most useful diagnostic modality was tissue sampling followed by imaging. Mantoux test is not unequivocal for the diagnosis of EPTB.
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Affiliation(s)
- Aruna Shanmuganathan
- Professor, Department of TB and Chest Diseases, Meenakshi Medical College and Research Institute , Enathur, Kanchipuram, Tamilnadu, India
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