[Analysis of the prevalence of nonspecific urinary tract infection in patients with tuberculosis among residents of the Bukhara region of the republic of Uzbekistan]

AIM

To analyze the prevalence of nonspecific UTI in patients with tuberculosis and to evaluate the efficiency of therapy and prevention measures.

MATERIAL AND METHODS

A total of 936 patients with tuberculosis of various localizations aged from 18 to 96 years were examined. There were 447 men (47.8%) and 489 women (52.2%). A diagnosis of nonspecific UTI was done using following criteria: the presence of characteristic symptoms, leukocyturia and bacteriuria detected by microscopic examination of the urine sediment, positive urine culture for nonspecific species, negative urine tests for Mycobacterium tuberculosis.

RESULTS

The prevalence of nonspecific UTI among 936 patients with tuberculosis was 18.6% (n=174). Non-specific species were determined in all forms of tuberculosis, but most often in urogenital tuberculosis (74.1%). Proposed therapeutic and prophylactic tactics included antibacterial therapy, herbal drug Kanefron N and sanitary measures. The efficiency of treatment was 94.6%. It should be noted that patients received anti-tuberculosis therapy, and there were no adverse reactions associated with a combination of drugs.

CONCLUSION

When choosing treatment tactics, it is necessary to take into account the presence of structural and functional changes in the urinary tract, which reduce treatment efficiency.

Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study

BACKGROUND

Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka.

METHODS

Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6-96).

RESULTS

There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26-75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease.

CONCLUSIONS

The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.

[Surgical treatment of patients with urogenital tuberculosis]

Despite the modest positive trends in the epidemic situation for tuberculosis, the incidence of extrapulmonary tuberculosis is not consistent. The relevance of urogenital tuberculosis remains high, as well as its social significance. Tuberculosis of the kidneys and urinary tract is often diagnosed late, when drug therapy is not enough and surgical treatment is required. A total of 78 national and foreign publications dedicated to surgical treatment of patients with urogenital tuberculosis were analyzed. Various surgical techniques for renal and bladder tuberculosis are described with a comparison of their advantages and disadvantages. Tuberculosis of the urinary system, like any infectious disease, can and must be cured with drug therapy. Unfortunately, there are complicating subjective (low alertness of doctors regarding tuberculosis, low adherence to national and international guidelines) and objective (absence of pathognomonic symptoms of urogenital tuberculosis, which results in late diagnosis, increased drug resistance of the pathogen, high comorbidity) factors. The advancements in surgical techniques and modern drugs for neoadjuvant therapy give patients the opportunity to receive minimally invasive treatment that saves not only life, but also provides them acceptable quality of life.

[The features of the recurrence of urogenital tuberculosis]

INTRODUCTION

Tuberculosis is an infectious disease, which can result in self-cure, chronic process or relapse course.

AIM

To analyze the incidence of recurrence of urogenital tuberculosis and to identify the features of patients with recurrent disease.

MATERIALS AND METHODS

Specially developed questionnaires on the structure of the incidence of extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were analyzed. We also studied 140 outpatient medical records of patients with tuberculosis of the urinary tract and male reproductive system, who was followed at the Novosibirsk Regional TB Outpatient Department. The medical records of patients with recurrent disease were analyzed in detail.

RESULTS

In 2019, 563 patients with isolated extrapulmonary tuberculosis in the Siberian Federal District and the Far Eastern Federal District were identified, and 14.4% of them had urogenital tuberculosis. In 99 (17.6%) patients, the present state was a relapse, while urogenital tuberculosis occupied 8.1%, and all patients were HIV-negative. In the Novosibirsk Region, 127 out of 140 patients were diagnosed with urogenital tuberculosis for the first time, and in 13 (9.3%) had recurrent disease. Among patients with relapse, male predominated (61.5%). The primary focus of tuberculosis was located in the genitourinary system in 53.9% of patients, which supports the theory of reactivation of dormant foci. In addition, 38.5% of patients with primary episode of tuberculosis were smear-positive. The average relapse time after successful cure of tuberculosis was 9.1 years. Among patients with recurrent urogenital tuberculosis, mycobacteriuria was recorded in 23.1% of cases, and in one case drug resistance of the pathogen to streptomycin and isoniazid was seen. In general, the kidneys were the most susceptible to relapses and were involved in 69.2% of cases.

CONCLUSIONS

Nearly 8.1-9.3% of patients with genitourinary tuberculosis had previously tuberculosis and were successfully cured. When urogenital tuberculosis recurs, the kidneys are affected in 69.2% of cases. The overwhelming majority (61.5%) of patients with recurrent genitourinary tuberculosis are men, therefore gender can be considered a predictor of recurrence. HIV infection was found in isolated cases in patients with both newly diagnosed and recurrent urogenital tuberculosis.

[History of epidemics in urology in German-speaking countries]

Pandemics are relevant for many fields of medicine from microbiology to economics and epidemiology. Many medical specialties which developed during the 19th century, e. g., urology, have had much impact on diagnostics and therapy, such as during the treatment of tuberculosis and sexually transmitted diseases. For some of them, including urology, treatment of, for example, sexually transmitted diseases, was constitutional and differed between countries.

Genitourinary tuberculosis in Taiwan: A 15-year experience at a teaching hospital

BACKGROUND

Genitourinary tuberculosis (GUTB) is rare but fatal if not diagnosed early. The purpose of this study was to investigate the outcomes of GUTB in Taiwan.

METHODS

We retrospectively reviewed medical records of 57 patients who were diagnosed as GUTB from January 2002 to December 2016, over a 15-year period. Demographic data and clinical manifestations were recorded for analysis.

RESULTS

There were 37 males and 20 females with a median age of 71 years. Kidney (24.6%) was the most involved organ. Fever (56.1%) was the major presentation. Sixteen (28.1%) patients presented unfavorable outcome. Compared with the favorable outcome group, the unfavorable outcome group had more malignancy (p = 0.013), fever (p = 0.020), anemia (p = 0007), thrombocytopenia (p = 0.003), and hypoalbuminemia (p = 0.015). In a multivariate analysis, fever (odds ratio: 42.716, 95% confidence interval: 1.032-1767.569; p = 0.048) was identified as prognostic factors for unfavorable outcome.

CONCLUSION

GUTB is often in advanced stages with a high mortality in Taiwan. Establishing a diagnosis is difficult and requires thorough investigation. Fever is associated with unfavorable outcome.

Tuberculosis of the Urogenital Tract in Adults in a Tertiary Referral Center

The genitourinary system is the main location of extrapulmonary tuberculosis. In Poland, it occupies the third place after tuberculosis of the pleura and lymph nodes. The aim of this study was to evaluate the prevalence and characteristics of tuberculosis in the urogenital tract in adult patients in a tertiary referral center in the years 2007-2015. The retrospective study included 87 patients, 42 women and 45 men. The average age was 62 ± 15 years. Changes in the urinary tract were diagnosed in 91% of women and 64% of men. Testicular tuberculosis was found in ten men, prostate tuberculosis in five, and in individual cases tuberculosis of the epididymis, scrotum, uterus, and the fallopian tube were found. The diagnosis was confirmed by bacteriological methods in 47% of patients, by histopathological in 41%, and by molecular methods in 23% of patients. In 84% of patients urological or gynecological interventions had to be applied. Patients were burdened with a number of urological diseases or diseases affecting other systems which hampered the diagnosis of tuberculosis. Antituberculosis treatment gave good results. Urogenital tuberculosis is a multivariate disease and a standard unified approach is impossible.

[Is there screening for urinary tuberculosis?]

INTRODUCTION

Most of the patients with genitourinary tuberculosis are detected too late. One of the reasons for this is the lack of a simple, cheap, reliable screening. The purpose of this study was to investigate the possibility of using a recombinant tuberculosis allergen (diaskintest) as a screening test to detect patients with genitourinary tuberculosis.

MATERIAL AND METHODS

This is a simple prospective, open-label cohort study comprising 197 patients admitted to the Novosibirsk Research Institute of Tuberculosis for differential diagnosis in 2014-2016. Of then, 72 patients were found to have urogenital tuberculosis, while 125 patients had chronic nonspecific infections.

RESULTS

The sensitivity of the Kochs subcutaneous tuberculin test and the diaskintest was 80.4% and 63.8%, respectively. The specificity of the Kochs test was 91.5%, which makes it still possible to consider it essential in the differential diagnosis of urogenital tuberculosis and nonspecific urogenital infections. A high percentage of positive diaskintest results in patients with chronic infectious and inflammatory diseases of the genitourinary system caused a low specificity of the test - 37.5%.

CONCLUSION

Diaskintest can be used in screening for genitourinary tuberculosis, but its positive result indicative for diagnosis. It may be used only as a reason for in-depth phthisiourological examination using additional provocative tests, in particular, Kochs test, which showed high diagnostic performance.

[The epidemiological situation of urogenital tuberculosis in Siberia and the Far East]

INTRODUCTION

Tuberculosis remains one of the most important problems of our time. Late diagnosis of urogenital tuberculosis (UGT) results from a lack of a clinician awareness, paucity of pathognomonic symptoms and suboptimal therapy for urinary tract infections while UGT often manifests under their disguise.

AIM

To determine the incidence of urogenital tuberculosis and its structure in an epidemiologically unfavorable region.

MATERIAL AND METHODS

The study compared the temporal changes in the structure of UGT morbidity from 1999 to 2015 in the Siberian and Far Eastern Federal Districts and analyzed outpatient medical records of 456 UGT patients.

RESULTS

The highest (46%) proportion of UGT in the structure of extrapulmonary disease was found in 2003, the lowest (22.9%) in 2014. According to outpatient medical records, the proportions of patients with stage 1, stage 2 and cavernous forms of nephrotuberculosis ranged from 21.2 to 37%, 26 to 53.5% and 21.6 to 37%, respectively. The incidence of prostate tuberculosis ranged from 0 in 2003 and 7.1% in 2008 to 54.2% in 2013, averaging to 33.9%.

CONCLUSIONS

Currently, it is impossible to estimate the true prevalence of UGT, we can only speak about the detection rate. Every fourth UGT patient was under the medical supervision with a wrong diagnosis for 5 or more years. The proportion of UGT in the structure of morbidity from all forms of extrapulmonary TB reached a minimum (22.9%) in 2014 but went up again. Introducing new technologies has led to an improvement of bacteriological verification of UGT and increased prostate tuberculosis detection rate to 35.7%.

[Extrapulmonary tuberculosis]

Each year, there are more than eight million new cases of tuberculosis and 1.3 million deaths. There is a renewed interest in extrapulmonary forms of tuberculosis as its relative frequency increases. Among extrapulmonary organs, pleura and lymph nodes are the most common. Their diagnosis is often difficult and is based on clinical, radiological, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and samplings, in most cases, difficult to obtain, so diagnosis is often simply presumptive. Nucleic acid amplification tests, which are fast and specific, have greatly facilitated the diagnosis of some forms of extrapulmonary tuberculosis. However, their sensitivity is poor and a negative test does not eliminate the diagnosis. Treatment is the same as for pulmonary forms, but its duration is nine to 12 months for central nervous system and for bone tuberculosis. Corticosteroids are indicated in meningeal and pericardial localizations. Complementary surgery is used for certain complicated forms.

Imaging findings of urinary tuberculosis on computerized tomography versus excretory urography: through 46 confirmed cases

BACKGROUND

Imaging findings of urinary tuberculosis (TB) on excretory urography (IVP) and CT have been reported to be nonspecific although CT may provide detailed informations. We performed a retrospective study of patients with proven urinary TB to compare imaging findings on IVP and CT and to make a systemic approach to imaging analysis of urinary TB.

METHODS

Urinary TB was diagnosed in 46 patients who had IVP and CT examinations prior to definitive diagnosis and treatment. They were 30 females and 16 males with a mean age of 43.6 ys. We assessed the presence and frequency of urinary tract calcifications, autonephrectomy, renal parenchymal masses, renal parenchymal scarring, moth-eaten calices, amputated infundibulum, renal parenchymal cavities, hydrocalycosis, hydronephrosis, hydroureter and thick urinary tract walls.

RESULTS

CT was most sensitive in detecting any renal parenchyma cavities (p=0.01), hydronephrois (p=0.0005), ureteral stricture (p=0.03) and walls thickening of the renal pelvis / ureter (p< 0.0001). Four imaging patterns were noted in 20 IVPs (43%) and 34 CTs (74%) with multiple findings. They were hydrocalycosis, hydronephrosis or hydroureter du to multiple stricture sites, ureteral stricture with thick wall, autonephrectomy combined with at least 1 other type of imaging finding and thick wall of renal pelvis or ureters and bladder with at least 1 other type of imaging finding.

CONCLUSIONS

Renal parenchymal cavities, hydronephrosis, ureteral stricture and thickened urinary tract walls were significantly more common on CT than on IVP. Multiple findings on CT were more common and very useful for TB diagnosis. Thus, we recommend CT as the standard exam in patients with suspicion of urinary TB.

[Urogenital tuberculosis today]

In order to analyze the structure of urogenital tuberculosis, retrospective analysis of medical records of 131 patients with newly diagnosed urogenital tuberculosis observed in the Novosibirsk Regional TB Dispensary from 2009 to 2011 was performed. The renal tuberculosis is main form in the structure is urotuberculosis, detected in 75% of patients, and widespread destructive forms of the disease were diagnosed in more than half of cases. Isolated nephrotuberculosis was more often diagnosed in women--56.8%. 15.9% of patients had asymptomatic nephrotuberculosis; one-third of patients complained of pain in the lumbar region and frequent painful urination (35.2 and 39.8%, respectively); symptoms of intoxication were present in 17% of patients, renal colic--in 9.1%, and gross hematuria--in 7.9% of patients. Mycobacteriuria in isolated nephrotuberculosis was detected in 31.8% of cases. Acute tuberculous orchiepididymitis developed in 35.7% of patients, hemospermia was observed in 7.1% of patients, dysuria was in 35.7% of patients. The pain in the perineum, frequent painful urination (both by 31.6%), hemospermia (26.3%) were main complaints in prostate tuberculosis. Mycobacteria was detected in 10.5% of cases. It was found that urogenital tuberculosis has no pathognomonic symptoms; the most alarming manifestations include long-term dysuria, hematuria, hemospermia.

Genito-urinary tuberculosis revisited--13 years' experience of a single centre

BACKGROUND

Tuberculosis had been declared by the World Health Organization (WHO) as 'public health emergency' in 1993. Extra pulmonary tuberculosis (E.P.T.B.) comprises 20-25% total burden of the disease in which genitourinary tuberculosis (GU.T.B.) is 4%. Timely diagnosis and treatment will prevent the sequelae of this disease.

AIMS

To know the varied clinical presentations, diagnostic modalities and management of G.U.T.B.

METHODS

During a 13-year-period, 117 retrospective cases of GUTB were admitted in the tertiary care centre. They were analyzed for clinical presentation, diagnostic modalities and management.

RESULTS

Young patients mainly in third decade of life were commonly affected with higher incidence in females. In our study, the most common presentation was irritative voiding symptoms (66.47%) followed by haematuria (47.60%). Although it can affect the entire organ in genito-urinary system but, in the present study, kidney was the most affected organ (64.9%) following ureter (27.35%), urinary bladder (17.09%), prostate (3.4%) and epididymis (5.19%). In this study, we had not encountered any case of testicular and penile tuberculosis. Among the different diagnostic modalities in this study, the diagnostic positivity rate was 41.6% for the urine AFB test, 55.4% for the urine M. tuberculosis culture test and 67.7% for PCR. Chest x-ray was positive in 25.6% (30). ESR was raised in 62.5% and Mantoux test was positive in 61.2% patients.

CONCLUSION

A high index of suspicion and a wide range of investigations may be required to achieve a complete diagnosis of genitourinary tuberculosis. Though short course chemotherapy with four-drug-regimen for six-month-duration is the mainstay of treatment, surgical interventions were required in 60% of cases of this study.

[Proportion and site distribution of extrarespiratory tuberculosis in 2007-2010 in Romania]

In the actual context of an increased TB endemia (notification rate of 90.5 per thousand, meaning 21457 cases in 2010, but with a constant decreasing trend in the last 8 years), we wanted to see what is the share and structure of extra-respiratory tuberculosis in the period 2007-2010. In the interval 2007-2010 have been registered annually between 1252-1267 extra-respiratory TB cases. Extra-respiratory TB have been between 30% and 42,1% from all TB cases registered annually with the extra-pulmonary TB. In the descending order of cases recorded with TB extra respiratory in 2010, the first was extra-thoracic ganglionary TB (244 cases), followed by osteo-articulary (233) and those of meningo-encephalitis and CNS TB (133). Location of TB on the spine remains the most common form of skeletal TB, representing 62.2% (145 cases) of all osteo-articulary locations. The number of registered cases of pericardial effusions TB annually remains steady at 40-50 cases. The number still high of meningo encephalitis TB (severe prognosis, epidemiological severity) involves enhanced accountability measures in TB control of the territory. The collaboration between the pulmonologist and the body specialist constitutes compulsory condition of quality assistance in case of TB extra respiratory sites.

Tuberculosis of the urinary tract in southern Thailand

BACKGROUND

The urinary system is one of the common sites of involvement of extrapulmonary tuberculosis (TB). The accurate diagnosis and treatment of extrapulmonary TB is complex and difficult.

OBJECTIVE

To address the epidemiology and drug susceptibility of urinary tract TB in southern Thailand.

MATERIAL AND METHOD

A retrospective analysis of data collected at the time of diagnosis of urinary tract TB cases, during a 10-year period from 1998 to 2007. Data collection included demography, presenting symptoms, laboratory investigations, and imaging studies of the urinary system.

RESULTS

During a 10-year period of the present study, 35 new cases of urinary tract TB were diagnosed, with a male/female ratio of 1.3:1 and a common age group of 31-40 years. 34.3% of the patients were farmers. The most presenting symptoms were polyuria, dysuria and acidic urinary pH with pyuria. 80% ofthe patients had abnormal imaging studies ofthe urinary system, with hydronephrosis being the most frequently found condition. Fifty seven point one percent had positive urine cultures for Mycobacterium and 0.05% of them had streptomycin resistance, while none ofthem had an HIV coinfection.

CONCLUSION

The urinary tract TB was more common in male with a common age group of 31-40 years. The common presenting symptoms were long-standing urinary symptoms as frequency in urination, dysuria, hematuria and acidic urinary pH associated with pyuria. In the present study, there was only 0.05% of streptomycin resistance, however, no patients with HIV infection.

Urinary Tuberculosis: Ten Years' Experience

In this study of 26 patients, clinical features diagnosed as urinary tuberculosis in our nephrology and urology clinics between 1993 and 2002 were investigated retrospectively. Fifteen patients (52%) were male, and mean age was 43.5 (18-71). Twenty percent of the patients were asymptomatic. Frequency-dysuria (46%), flank pain (33%), and macroscopic hematuria (12%) were presenting symptoms. Physical examination was not diagnostically helpful in most patients. Hematuria and/or pyuria were detected in 80% of the patients. Eleven patients had positive urine cultures of Mycobacterium tuberculosis (42%), and 7 patients had positive smears (25%). Definitive diagnosis of urinary tuberculosis was established microbiologically in 15 patients (58%) and histopathologically in 11 patients (42%). Tuberculin skin test was positive in 60% of the patients. Eight patients had an abnormal chest roentgenogram. Hydronephrosis (majority bilateral) in 11 patients (42%), contracted bladder in 9 patients (34.6%), and renal calcification in 6 patients (23%) were detected. Two patients also had genital tuberculosis (epididymoorchitis). Although only medical treatment was applied in 13 patients for 9 months, in the rest of the patients medical therapy plus surgical intervention was carried out. End-stage renal failure developed in one patient who died on hemodialysis. Renal functions had decreased moderately in two other patients. In conclusion, the diagnosis of urinary tuberculosis was able to be established after the obstructive complications and functional losses were developed in a fair number of cases. Surgical treatment was carried out in half the patients. Urinary tuberculosis should be taken into consideration because early diagnosis and treatment is very important for the presenting of irreversible sequelae.

Salubrious Effect of Vitamin E Supplementation on Renal Stone Forming Risk Factors in Urogenital Tuberculosis Patients

The incidence of renal calculi has been evaluated to be 25% in urogenital tuberculosis patients. The stone could be caused due to the host, the pathogenic organism, or possibly by the treatment. Studies were carried out to find out the efficacy of vitamin E supplementation in reducing the risk of stone formation in renal tuberculosis patients. The study constituted four groups, Group I with 30 normal volunteers, the second group comprised of 36 renal tuberculosis patients (GuTb) a day before treatment. Third group comprised of 24 patients with regular anti tuberculosis drug regimen for sixty days. In the fourth group, 12 patients were treated with anti tuberculosis drug regimen along with supplementation of antioxidant vitamin E (200 mg/day) for sixty days. Hyperuricosuria and hypercalciuria were observed in group II and group III patients, along with increased excretion of oxalate and creatinine, accompanied by decreased excretion of inhibitors such as citrate and glycosaminoglycans (GAGs). Renal damage was evident with increased leakage of Lactate dehydrogenase (LDH), Alkaline phosphatase (ALP) and gamma-Glutamyl transferase (gamma-GT) in renal tuberculosis patients. From the results of the above study, it is obvious that increased urinary oxalate levels leads to cellular damage in GuTb patients, which is a prerequisite for crystal retention as revealed by the elevated urinary marker enzymes. Antioxidant therapy prevents membrane injury thereby reducing the risk of stone formation. Hence vitamin E supplementation has a salubrious effect in preventing stone forming tendency with routine anti tuberculosis drug regimen.

[Prevalence of tuberculosis among children and adolescents in the Russian Federation: analysis of official statistics]

The paper provides the analysis of the prevalence rates of tuberculosis among children and adolescents in the Russian Federation, which has been made on the basis of the data available in official reporting forms Nos. 8, 33 (approved by the Resolution of the Russian Statistics Agency on November 11, 2005), and 47 (approved by Resolution No. 175 of the Russian Statistics Agency on September 10, 2002). Correlations between epidemiological indices have been calculated and assessed. The age-related features of the occurrence and course of tuberculosis have been studied among various age groups of children. It is concluded that in this situation in order to improve the epidemic situation among children and adolescents, emphasis should be primarily placed on the activation of intersectoral interaction of primary health care and tuberculosis service: to actively attract general practitioners, local pediatricians and therapists to prophylaxis in children.

[Tuberculosis after renal transplantation]

Renal transplant recipients carry a relatively high risk of developing tuberculosis (TB). In most cases, active TB is the result of reactivation of a latent infection and is located in the lungs. In these patients, clinical presentation of TB can often be atypical and there is a high risk of dissemination and high mortality rates. Therefore, the use of invasive procedures for proper diagnosis is recommended, as well as anti-tuberculosis therapy instituted whenever there is a strong suspicion of TB on clinical grounds, even without microbiological evidence. The treatment of active TB in renal transplant recipients should be the same as in the general population. To avoid graft rejection, blood levels of calcineurin inhibitors should be monitored closely. Prophylaxis is recommended for high-risk patients.

[The factor analysis in the study of the tuberculosis of the urino-genital organs]

The results of the study of the prevalence of tuberculosis of the urino-genital system in the city of Omsk are presented. The quality of the corresponding medical care, the disease outcomes and the actual state of the prevention of the tuberculosis of the urino-genital organs are discussed. The factor analysis based on the Iberia approach was applied.

Current survey of urinary tuberculosis in Hokkaido, Japan

Urinary tuberculosis has been rare in recent years and its diagnosis is difficult because there are no disease-specific symptoms. We tried to clarify the occurrence of urinary tuberculosis in recent years in our area. During the past 5 years, there were 12 patients with urinary tuberculosis in the clinics that participated in this study. Their chief complaints were frequent voiding in 7 patients and gross hematuria in 3 patients. They were diagnosed by nucleic acid amplification tests and imaging modalities such as excretory urography, computed tomography, and/or cystoscopy. Most of the patients received multidrug treatment and had relatively favorable treatment outcomes. There has been a small but neglected number of patients with urinary tuberculosis in recent years. We should keep this rare and difficult-to-diagnose disease in mind and suspect it when patients complain of longstanding urinary symptoms with no obvious cause.

Male genital tuberculosis in Siberians

To study the epidemiology and the clinical picture of male genital tuberculosis in Siberia, Russia. Five hundred and fourteen patients with genitourinary tuberculosis were enrolled in the study: 414 had kidney tuberculosis only, 100 had genital involvement. The clinical picture and structure of genital tuberculosis were investigated: 42 had tuberculosis of scrotal organs and 58 had tuberculosis of the prostate. Urinary cultures, urinalysis, three-glass test, and investigation of the prostate secretion, Mycobacteria culture, and susceptibility testing were performed in all 514 patients. 33.6% of all patients earlier suffered from pulmonary or extrapulmonary tuberculosis and were successfully cured. In 61.9% nephrotuberculosis was diagnosed alongside with an orchiepididymitis. In 30.9% of patients bilateral epididymorchitis was diagnosed. Mycobacteriuria was present in 38.1%. Scrotal fistula was found in 11.9%. In 66.7% the symptoms appeared acutely. Half of the patients with prostate tuberculosis complained of dysuria, 23 (39.6%) had perineal pain, 34 (58.6%) had flank pain. Leucocytes in urine were present in 49 (84.5%) patients, and in prostatic secretion in 45 (77.6%) patients. Erythrocytes in urine were present in 31 (53.4%) patients, and in prostatic secretions in 17 (29.3%) patients. Male genital tuberculosis has no specific pathognomonic signs. Using a special algorithm for the management of patients with prostatitis or epididymitis is recommended.

[Frequency of microbiologicaly diagnosed urinary system tuberculosis in Tuzla canton area]

In this study we analyzed microbiology results of tuberculosis in urinary system, in the area of Tuzla canton in period since 1993 to 2005 year. For microbiological diagnosis we tested samples of whole morning urine by method of concentration and homogenization by Petroff and inoculated on Loewenstein culture media. All grown culture was identified biochemical by production of niacin, reduction of nitrate and production of heat labile catalase. In this investigated period we tested 121,945 samples of different biological materials on Mycobacterium tuberculosis: sputum 89,433, gastrolavate 5,122, broncholavate 1,337, pleural exudation 1,356, punctuates 1,711, liquors 179, stools 149, blood 4, urine 22,654 samples. All urine samples were taken from 4,192 patients. Positive culture is found in 358 urine samples or in 1, 58%, or 173 patients or 4, 13%. From total 4,759 microbiologically diagnosed patients with all different types of tuberculosis in this period of time, with pulmonary tuberculosis there was 4,495 or 94, 45% patients and 264 or 5, 55% with extrapulmonal types of tuberculosis. Tuberculosis of urinary system is microbiologically diagnosed in 173 or 3, 63% patients out of total number of diagnosed tuberculosis cases. Tuberculosis of urinary system is diagnosed in 115 women and 58 men. In both sexes it was most often diagnosed in age of 65 to 74 year and in women in age of 45 to 54 year and in man in age 25 to 34 year. Tuberculosis of urinary system is more common in patients from Tuzla then from other town in Tuzla canton. It is also more common in patients that were treated in Clinic then those who were treated ambulatory. We can conclude that distance of place of living from place of microbiology laboratory significantly influence on microbiologically diagnostic of tuberculosis of urinary system.

Genitourinary tuberculosis in Nigeria; a review of thirty-one cases

OBJECTIVE

To report and discuss the characteristics of genitourinary tuberculosis as observed in a sub-Saharan African setting, where reports suggest its rarity despite reported high incidence and prevalence of pulmonary tuberculosis.

PATIENTS AND METHOD

Thirty one consecutive patients with discharge diagnoses of genitourinary tuberculosis seen in a small community-based hospital over a five-year period were retrospectively studied.

RESULT

There were 28 males and three females, with a mean age of 37.6 (SD 11.5) years. Forty- three sites were involved in seven organs: epididymis 25 (58.1%), kidney 7 (16.3%), testis 4 (9.3%), bladder 3 (7.0%), ureter 2 (4.7%), prostate 1 (2.3%), and cord of the testis 1 (2.3%). The commonest presenting features were scrotal/testicular mass with or without pain/tenderness (80.6%), fever/headache (51.6%), and dysuria (22.6%). Other common features were back, loin, or abdominal pain/tenderness. hydrocoele, scrotal abscess, and haematuria. 26.9% had evidence of concurrent or previous pulmonary tuberculosis, and 9.1% were positive on HIV 1 & 11 screening.

CONCLUSION

With the prevailing conditions in sub-Saharan Africa and most of the developing world and the slightly different characteristics of the disease in our environment, diagnosis of genito-urinary tuberculosis may be difficult. It is advised that patients with unexplained symptoms in the urinary tract should be investigated for tuberculosis.

EAU Guidelines for the Management of Genitourinary Tuberculosis

Nearly one third of the world's population is estimated to be infected with Mycobacterium tuberculosis. Moreover, tuberculosis is the most common opportunistic infection in AIDS patients. Genitourinary tuberculosis is not very common but it is considered as a severe form of extra-pulmonary tuberculosis The diagnosis of genitourinary tuberculosis is made based on culture studies by isolation of the causative organism; however, biopsy material on conventional solid media may occasionally be required. Drug treatment is the first line therapy in genitourinary tuberculosis. Treatment regimens of 6 months are effective in most of the patients. Although chemotherapy is the mainstay of treatment, surgery in the form of ablation or reconstruction may be unavoidable. Both radical and reconstructive surgery should be carried out in the first 2 months of intensive chemotherapy.

Poncet's disease (tuberculous rheumatism): two case reports and review of the literature

We report two human leukocyte antigen (HLA) B27-positive cases of urogenital tuberculosis (TB) with asymmetric polyarthritis. Stained smears with Ehrlich Ziehl-Neelsen and polymerase chain reaction (PCR) tests for Mycobacterium tuberculosis complex (MTC) of the ejaculate were positive in both cases, despite negative cultures. Stained smear, culture and PCR results of the synovial fluid for mycobacteria were negative. The patients were diagnosed with Poncet's disease. Polyarthritis was resolved rapidly with anti-tuberculosis treatment. We suggest that in cases with unexplained arthritis and non-articular TB, Poncet's disease should be considered. PCR can be used in the routine diagnostic algorithm when conventional methods fail to identify MTC.

[Disability in patients with urogenital tuberculosis]

The timely diagnosis of urogenital tuberculosis and the early initiation of specific therapy are an essential prerequisite to the maximum maintenance of function of an affected organ and to a good prognosis of the disease. Analysis of 205 history cases in patients with new-onset urogenital tuberculosis who were examined and treated at our hospital in 1999-2003 has revealed advanced destructive urogenital tuberculosis in 56.1% of cases. The able-bodied patients were 58.05%. Medical examination determined disability group II in 27.8%. The able-bodied patients who were recognized to be disabled were 57.89%. Since the highest disability rates (34.15%) among the patients with new-onset urogenital tuberculosis were observed in the group of the most able-bodied age (41-50 years), this condition inflicts a great economic loss. The true disability rates are higher than those observed by us since some patients undergo medical examination in their local tuberculosis dispensaries and fail to be statistically registered at our hospital.

[Active detection of patients with tuberculosis of urinary organs from increased risk groups at the polyclinics of the general therapeutic-and-prophylactic network]

To timely detect tuberculosis of urinary organs (TUO), the authors have proposed a procedure for detecting the disease in increased risk groups. By analyzing 272 cases with TUO and 12 control persons, they established the most important risk factors. The authors have developed a procedure for stratification of contingents and differential measures in accordance with the risk (three degrees). The procedure has shown to be effective.

[Combined clinical forms of pulmonary and extrapulmonary tuberculosis]

60 medical reports of patients with combination of pulmonary and urogenital organs tuberculosis were analyzed. Our study has shown that with heightening sickness rate of all forms of tuberculosis including pulmonary tuberculosis one can notice a slight rise of extrapulmonary tuberculosis. It can be explained first of all by difficulty in diagnosing extrapulmonary tuberculosis and absence of professional watchfulness to a possibility of combination of pulmonary and extrapulmonary tuberculosis. For example, in 45.3% of all cases with no positive effect of antibiotic therapy wasn't taken into account additional diagnostic methods for finding etiologic agent of the pathological process (Mantu test with 2 TU, Koh test with 50-100 TU, biological test, plan X-ray film of lungs, ultrasonic diagnostics of visceras, urine inoculation for MBT before treatment) and patients often were found with advanced tubercular process as in lungs so in urogenital organs.

[The epidemiological and clinical aspects of extrapulmonary tuberculosis in children and adolescents in Primorsk Region]

The incidence of extrapulmonary tuberculosis has been studied in children and adolescents in the Primorye Territory in 1996 to 2001. There is a decrease in the incidence and prevalence of extrapulmonary tuberculosis in both children and adolescents, which does not reflect the true situation as the process is more frequently diagnosed on their referral in the period of late clinical manifestations. Young age children have fallen ill more frequently (54.7%); 76% of the patients were identified on their referral. Most children are permanent residents and live in the high- and middle-class families. In the clinical pattern, there were predominant ostcoarticular forms of tuberculosis running with a complication of the underlying disease in 80%. The study suggests that there are great gaps in the detection of extrapulmonary tuberculosis in children.

Tuberculosis in Egyptian kidney transplant recipients: study of clinical course and outcome

BACKGROUND

Tuberculosis (TB) is an important infection encountered post-transplantation especially in developing countries, with high incidences of morbidity and mortality. In this report, we study the risk factors and impact of TB on the outcome of kidney transplantation.

METHODS

Of 1200 live-donor Egyptian kidney transplantations, 45 (3.8%) patients developed post-transplant TB. Of these, five had had TB pre-transplantation and 40 were male. The mean age was 32.6 +/- 10.5 years. Primary immunosuppression treatment for 39 (86.7%) patients was cyclosporine (CsA).

RESULTS

The mean time interval between transplantation and TB diagnosis was 49.8 +/- 41.5 (range 2-180) months. In 86.7% of patients, TB was diagnosed one year post-transplantation. Urinary TB was the most common form (53%), while pleuropulmonary TB accounted for 38%. All post-transplant TB patients received a triple anti-tuberculous therapy (rifampicin, ethambutol and INH) with a favorable response in all but two patients who needed another 24-month course. Hepatotoxicity was seen in 11 patients, eight were mild with normalization after temporary withdrawal of rifampicin, and three cases were severe, but mortality was not attributable to hepatocellular failure. Twelve patients died, 11 of them due to unrelated causes. Chronic rejection occurred in more than half of the patients (55.6%), of whom 24 (96%) were CsA-treated, which can be attributed to rifampicin/CsA interaction. More than 35% of TB patients lost their graft as a result. Pre-transplant tuberculosis patients had a comparable post-transplant course.

CONCLUSIONS

TB is a common infection in renal transplant recipients with a peak incidence occurring one year post-transplant. Chronic rejection is a serious complication that had a negative impact on the graft survival, especially in CsA-treated recipients. INH prophylaxis is safe in pre-transplant TB. The post-transplantation outcome in the pre-transplant tuberculosis patients is no different from non-TB patients.

Genitourinary tuberculosis: a review of 174 cases

In 174 cases of genitourinary tuberculosis diagnosed and treated in our clinic we evaluated, retrospectively, age and sex distributions, symptoms, physical and laboratory findings, primary focus, surgical and medical treatments. Flank pain and non-specific urinary complaints, e.g. dysuria, were the major symptoms. Although some authors prefer short-term medical therapy for the treatment of genitourinary tuberculosis, the relapse rate in our series after 12 months of therapy was 19% and we therefore suggest that therapy should be continued for at least 12 months. The poor nutritional status and social conditions characteristic of subjects from our region may, however, have influenced this high relapse rate.

[Extrathoracic forms of tuberculosis in Mahajanga hospitals (Madagascar)]

Pathological samples issued from patients suspected of extrapulmonary tuberculosis were examined in Laboratories of Mycobacteria and of Histopathology at the Androva Hospital in the University Hospital Centre of Mahajanga. A retrospective study was carried out from 1989 to 1993. During this period, 64 cases of extrapulmonary tuberculosis were recorded. Samples came from Androva Hospital, from Lutherian Hospital of Antanimalandy and from the Medical Centre of Mahabibo. The sex-ratio was of 1.28/1, mean age was 28 years old (extreme ages: 1-78 years old). The diagnosis was confirmed by bacteriological and/or histopathological examinations. Ganglial tuberculosis were the most frequent (53.1%), then digestive tract tuberculosis (20.2%) and anal fistula tuberculosis (14%). In front of chronic lesions, biopsies must be performed to obtain confirmation of diagnosis.

Non-pulmonary tuberculosis

Tuberculosis (TB) is a serious disease of global importance, with a rising incidence in the developed world in recent years. Tuberculous lymphadenitis, tuberculous meningitis, osteoarticular tuberculosis and miliary tuberculosis are some of the more well-recognised manifestations of non-pulmonary TB in childhood. The diagnosis of non-pulmonary TB poses a particular challenge for clinicians because of the protean ways in which the disease presents. The omission of tuberculosis from the differential diagnosis of patients with obscure illnesses and the relatively insensitive bacteriological methods for detecting Mycobacterium tuberculosis add to the complexity of the problem. A high index of suspicion is required in order to avoid delays in diagnosis which may influence treatment outcome. The advent of DNA amplification techniques such as the polymerase chain reaction may herald a promising new era in the prompt and accurate management of extrapulmonary tuberculosis.

[Extrapulmonary tuberculosis in children in Russia (epidemiology, clinical forms and their study)]

The paper provides the data of comprehensive epidemiological and clinical studies made at the Clinic of Tuberculosis in Children and Adolescents. Research Institute of Phthisiopulmonology, I. M. Sechenov Moscow Medical Academy, Ministry of Health of the Russian Federation, in the past 15 years and dedicated to extrapulmonary tuberculosis in children and adolescents with tuberculosis. Due to the specific features of manifestations of extrapulmonary tuberculosis in childhood and adolescence and to the existing system of prevention and early detection of the disease in children and teenagers in the Russian Federation, the number of children with severe generalized extrapulmonary tuberculosis is not on the rise despite that the epidemiological situation has aggravated in the past 15 years. The clinical features of most common forms of extrapulmonary tuberculosis are shown and measures for their monitoring proposed.

Does tuberculosis after kidney transplantation follow the trend of tuberculosis in general population?

Despite improvement in graft survival, infection continues to be an important cause of morbidity and mortality after kidney transplantation. We analyzed the clinical courses and outcomes of 16 transplanted patients with positive cultures for mycobacterium tuberculosis. In the course of a 20 year period, there were 13 cases of tuberculosis registered that developed in 456 patients who underwent kidney transplantation in our department, and in three refugees transplanted in other centers (a prevalence of 3.13%). Five of them developed tuberculous infections during 1997. Five patients had residual tuberculosis in preoperative chest X-ray, and specific pyelonephritis as an underlying kidney disease in two of them. All patients with treated with triple immunosuppressives. Before tuberculosis onset, 14 patients experienced one or more episodes of acute rejection and were treated with steroid pulses, ALG or OKT3. Tuberculosis was diagnosed after a period of 1.5 months to 10 years after transplantation. At the time of an infection, the graft function was normal in eight patients and chronic graft failure was evident in eight patients (sCr 210-700 micromol/L). The infection was pulmonary in 12 patients; urinary in two; disseminated in two; pulmonary and urinary, pulmonary and intestinal, and pancytopenia in one patient. All patients were treated with rifampicin and isoniazid in addition to ethambutol for the first two-month period. Treatment lasted from 1-22 months. With 14 patients favorable microbiological responses were registered. Two patients died within the first six months (both with disseminated disease), and the mortality rate was 14.3%. Throughout the followup period, the graft function remained stable and normal in eight patients who had normal graft function at the time of infection onset. Although six patients recovered, progressive graft failure developed and hemodialysis was restarted in one patient two months after antituberculous therapy introduction, and in two patients three years later. Four patients died 2-14 months after AT therapy withdrawal. The causes of death were severe liver failure, cerebrovascular insult and CMV.

[Epidemiological analysis of extrapulmonary tuberculosis in Shanghai]

OBJECTIVES

To find out the epidemiological characteristics of extrapulmonary tuberculosis (TB) in Shanghai, and to explore value of this surveillance.

METHODS

Distribution of extrapulmonary TB for sex, age and suffering site 1996-1999 were analyzed. In addition, its incidence trend and mortality were also investigated. All registered cases from ten urban districts of Shanghai were included.

RESULTS

The new registration rates of extrapulmonary TB 1996-1999 were 4.65-5.78/100,000. The proportion of extrapulmonary TB to all TB was 9.7%-11.8%. The extrapulmonary TB accounted for 14.1%-17.6% of all death due to TB. The rankings of extrapulmonary TB were as follows: lymph node TB (38.3%), bone and joint TB (19.9%), urinary and genital TB (16.7%), intestine and peritoneum TB (9.1%), cerebral and nervous TB (6.4%). The sex ratio of male to female was 1 to 1.35. The new registration rates of extrapulmonary TB increased with age except that of cerebral and nervous TB was the highest in middle and young age group.

CONCLUSIONS

Surveillance on extrapulmonary TB is an important part of TB surveillance, with significant value for TB control.

[Urinary bladder cancer in patients with tuberculous and post-tuberculous cystitis]

125 patients with tuberculous and posttuberculous cystitis were examined using cytological test of the aspirate from the bladder for atypical cells and histological investigation of the biopsy. Cancer of the bladder has developed in long-term chronic tuberculous or posttuberculous cystitis in 4% of the cases. The best objective method of the diagnosis was histological examination of the biopsy obtained from cancer-suspected sites of the bladder mucosa.

[Urogenital tuberculosis in the Ukraine population]

The prevalence and incidence rates of urogenital tuberculosis in the Ukraine in the past 10 years were studied. They tended to decrease in the first period (1988-1992) and to become stable in the second period (1993-1997), being equal to 10.71 and 1.0 per 100,000. In the past 5 years, the incidence of urogenital tuberculosis tended to increase among urban residents as compared to rural ones. These changes show a total trend in the population living in the radioactively polluted area.

[Epididymal manifestations of urogenital tuberculosis]

The morbidity of tuberculous epididymitis is due to the risk of male infertility secondary to vasal or epididymal obstruction or testicular necrosis. The aim of this study was to emphasize the epidemiological, clinical and therapeutical aspects of tuberculous epididymitis in adult. About eleven cases of epididymal localisation of urogenital tuberculosis, it appears that the diagnosis of the condition is rather difficult and often necessitate pathological exam of a specimen of epididymectomy. In other aspects, if antituberculous drugs are always effective in initial stages, surgery is usually radical, and rarely conservative. The latter procedures are vasovasostomy or vasoepididymostomy whose results are very hazardous.

[Comparison of cases of isolated pulmonary tuberculosis with cases of other localizations of tuberculosis in the course of an active surveillance (Gironde, 1995-1996)]

PURPOSE

Data collected during the years 1995 and 1996 in the course of an epidemiological survey of tuberculosis in Gironde allowed comparison of pulmonary tuberculosis with extrapulmonary localizations, evaluation of the importance of each localization and highlighting of potential risk factors.

METHODS

Patients living in Gironde who had evidence of either clinical, radiological or bacteriological expression of tuberculosis were included in the survey. Statistical comparisons were done using either Pearson's Chi 2 or Fisher's exact test.

RESULTS

The survey included 292 cases subdivided into 183 cases of pulmonary tuberculosis (63%) and 109 cases in which another localization had been diagnosed (37%). Extrapulmonary localizations that were the most often encountered either alone or in association with pulmonary localization were the following: lymphadenopathy (32%), pleural (28%), genito-urinary (12%) and osteo-articular localizations (7%). The survey showed that patients in whom tuberculosis localization was extra-pulmonary were more frequently under 20 years of age or over 60 years of age (P < 0.04). These patients also presented more often with HIV-infection (P < 0.02).

CONCLUSION

Extrapulmonary localizations of tuberculosis should be systematically investigated in young and elderly patients as well as in HIV-infected patients.

[Clinical study on 17 cases of genitourinary tuberculosis]

Between 1987 and 1995, 17 patients with genitourinary tuberculosis were treated at Iwate Prefectural Central Hospital. The incidence of newly diagnosed genitourinary tuberculosis was 17 out of 16,363 outpatients (0.1%) during the 9-year period. Twelve patients had urinary tuberculosis and genital as well as urinary organs were affected in 5. Six (35%) patients presented in their fifties and 5 (29%) each in their forties and sixties. Nine (53%) patients had irritative voiding symptoms as the chief complaint. Only 29% had a known history of extra-genitourinaty tuberculosis. In addition to the standard multidrug chemotherapy, nephrectomy was performed in 5 patients and orchiectomy in 2 with epididymal tuberculosis. The incidence of tuberculosis has recently increased in many parts of our country and more attention should be paid to genitourinary tuberculosis.

[Characteristics of nephrotuberculosis in children, adolescents and young persons]

According to the author, urogenital tuberculosis in children and young subjects occurs in 10% of all the cases with this disease. Antituberculosis service registers 71.2% of cases in preschool children, whereas in schoolchildren 70.4% of diagnoses are made by general practitioners. 90% of nephrotuberculosis cases are detected early, in 85% bacteriological examination.

Factors determining ethnic differences in the incidence of bacteriologically confirmed genitourinary tuberculosis in south east England

In South East England, genitourinary (GU) tuberculosis is a much less common manifestation of non-respiratory tuberculosis in patients of Indian subcontinent (ISC) ethnic origin than in those of European ethnic origin. When considered in relation to all bacteriologically confirmed cases of tuberculosis, both respiratory and non-respiratory, the ethnic difference in the occurrence of GU tuberculosis is much less evident, while there is a highly significant excess of other forms of non-respiratory tuberculosis among the ethnic ISC patients. Unlike other forms of non-respiratory tuberculosis, GU disease tends to occur in an older age range in the ethnic ISC population and, when stratified for age, the ethnic difference in the occurrence of this form of tuberculosis is not significant while that of lymph node tuberculosis remains significantly high. Thus, after elimination of the confounding factor of age, the occurrence of GU tuberculosis is very similar in the two ethnic groups while other forms of non-respiratory tuberculosis differ considerably.

Genitourinary tuberculosis: the importance of early diagnosis and management. Case presentation

Genitourinary tuberculosis is the second most common form of extrathoracic tuberculosis. The most common signs are persistent sterile pyuria in up to 90% of patients, irritative voiding symptoms and painless hematuria in up to 80% of the patients. In Puerto Rico the incidence of tuberculosis is rising, being 9.2 per 100000 population in 1992. A.I.D.S. has had a steady rise since 1983. With the rise in the incidence of both diseases and with the influx immigrants from countries were tuberculosis is endemic we should expect a rise in the number of cases of genitourinary tuberculosis. Chemotherapy is the mainstay of treatment. Surgery is performed less often. Early recognition and management is important to avoid irreversible damage to the genitourinary tract. The cases of a 43 y/o man and a 30 y/o male with A.I.D.S. are discussed.

Extra-pulmonary tuberculosis in Lothian 1980-1989: ethnic status and delay from onset of symptoms to diagnosis

We have retrospectively determined the incidence and delay in diagnosing extrapulmonary tuberculosis (ETB) by ethnic group in Lothian, Scotland, from 1980-1989. One hundred and sixteen (13.3%) of 874 TB notifications were for ETB. Eighty-seven records were available for analysis: 59 with a mean age of 57.9 years (range 10-90) were Caucasian (C) and 28 with a mean age of 30.3 years (range 10-86) were non-Caucasian (NC). There were 42 cases of lymphatic TB; 23 (7M,16F) with a mean age of 62 years (range 10-82) were C and 19 (14M,5F) with a mean age of 29 years (range 10-60) were NC. Lymphatic TB was a significantly commoner ETB site in NC (67.9%) cf C (39%) (P < 0.01). Of 24 cases of genito-urinary TB, 23 (14M,9F) with a mean age of 54 years (range 24-82) were C compared to one NC male aged 29 years. Genito-urinary TB was a significantly commoner ETB site in C (39%) cf NC (3.6%) (P < 0.001). Bone and joint TB was found in 11 (5M,6F) C with a mean age of 55 years (range 28-86) compared to five (3M,2F) NC with a mean age of 36 years (4-47). Five cases of abdominal TB (2C,3NC) were also identified. Delay from onset of symptoms to diagnosis for lymphatic TB was significantly longer for NC (mean 26 weeks, range 0-156) than for C (mean 9 weeks, range 2-28) (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)