TY - JOUR
T1 - High proportion of extrapulmonary tuberculosis in a low prevalence setting
T2 - a retrospective cohort study
AU - Sama, J. N.
AU - Chida, N.
AU - Polan, R. M.
AU - Nuzzo, J.
AU - Page, K.
AU - Shah, M.
N1 - Funding Information:
This study was supported by grants from the National Institutes of Health (M. Shah: K23 grant AI089259 ; N.Chida: T32 grant AI007291-23 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The National Institutes of Health did not contribute to the design, collection, analysis, or interpretation of data, nor did it contribute to the writing of the manuscript or the decision to submit the manuscript for publication.
Publisher Copyright:
© 2016 The Royal Society for Public Health
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Objectives The proportion of extrapulmonary tuberculosis (EPTB) cases in the United States (US) has been rising due to a slower rate of decline in EPTB compared to pulmonary tuberculosis (PTB). The purpose of this study was to characterise the clinical and treatment differences between EPTB and PTB patients, and identify patient factors associated with EPTB. Study design We performed a retrospective cohort study of active tuberculosis (TB) cases treated at the Baltimore City Health Department between 2008 and 2013. Methods We categorised patients as having ‘only PTB’ (infection in the lung parenchyma), ‘EPTB/PTB’ (infection in the lung and an additional site), and ‘only EPTB’ (infection not involving the lung). Pearson's chi-squared tests were used to evaluate categorical variables and compare clinical and demographic differences between only PTB, only EPTB, and EPTB/PTB patients. Student t-tests and one-way analysis of variance tests were utilised to assess continuous variables and to compare treatment differences. Results One hundred and sixty-three patients were treated for TB; 39.3% had some form of EPTB (either EPTB/PTB or only EPTB). There was no difference found between EPTB, PTB, and EPTB/PTB patients with respect to HIV status, gender, race, foreign-born status, or mean age. Patients with only EPTB were less likely than patients with some form of PTB (only PTB or EPTB/PTB) to present with cough (30.4% vs 61.5%; P < 0.001), night sweats (10.9% vs 39.3%; P < 0.001), and weight loss (28.3% vs 47.9%; P = 0.023). Patients with some form of EPTB were also more likely to be hospitalised postdiagnosis compared to patients with only PTB (39.1% vs 20.2%; P = 0.009), and to have longer mean durations of treatment (37.9 weeks [SD = 11.1] vs 31.8 weeks [SD = 8.1]; P < 0.001). Conclusions EPTB patients present with atypical symptoms, undergo prolonged treatment, and experience increased hospitalisations. In order to improve diagnostic algorithms and treatment modalities, EPTB must be further characterised.
AB - Objectives The proportion of extrapulmonary tuberculosis (EPTB) cases in the United States (US) has been rising due to a slower rate of decline in EPTB compared to pulmonary tuberculosis (PTB). The purpose of this study was to characterise the clinical and treatment differences between EPTB and PTB patients, and identify patient factors associated with EPTB. Study design We performed a retrospective cohort study of active tuberculosis (TB) cases treated at the Baltimore City Health Department between 2008 and 2013. Methods We categorised patients as having ‘only PTB’ (infection in the lung parenchyma), ‘EPTB/PTB’ (infection in the lung and an additional site), and ‘only EPTB’ (infection not involving the lung). Pearson's chi-squared tests were used to evaluate categorical variables and compare clinical and demographic differences between only PTB, only EPTB, and EPTB/PTB patients. Student t-tests and one-way analysis of variance tests were utilised to assess continuous variables and to compare treatment differences. Results One hundred and sixty-three patients were treated for TB; 39.3% had some form of EPTB (either EPTB/PTB or only EPTB). There was no difference found between EPTB, PTB, and EPTB/PTB patients with respect to HIV status, gender, race, foreign-born status, or mean age. Patients with only EPTB were less likely than patients with some form of PTB (only PTB or EPTB/PTB) to present with cough (30.4% vs 61.5%; P < 0.001), night sweats (10.9% vs 39.3%; P < 0.001), and weight loss (28.3% vs 47.9%; P = 0.023). Patients with some form of EPTB were also more likely to be hospitalised postdiagnosis compared to patients with only PTB (39.1% vs 20.2%; P = 0.009), and to have longer mean durations of treatment (37.9 weeks [SD = 11.1] vs 31.8 weeks [SD = 8.1]; P < 0.001). Conclusions EPTB patients present with atypical symptoms, undergo prolonged treatment, and experience increased hospitalisations. In order to improve diagnostic algorithms and treatment modalities, EPTB must be further characterised.
KW - Baltimore city
KW - Extrapulmonary tuberculosis
KW - Foreign born
KW - Tuberculosis
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U2 - 10.1016/j.puhe.2016.03.033
DO - 10.1016/j.puhe.2016.03.033
M3 - Article
C2 - 27137870
AN - SCOPUS:84964681405
VL - 138
SP - 101
EP - 107
JO - Public Health
JF - Public Health
SN - 0033-3506
ER -