Epidemiology of Extrapulmonary Tuberculosis in the United States, 1993-2006
Epidemiology of Extrapulmonary Tuberculosis in the United States, 1993-2006
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DOI：
10.1086/605559
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发表时间：
2009-11-01
影响因子：
11.8
通讯作者：
Armstrong, Lori R.
中科院分区：
文献类型：
--
作者：
Peto, Heather M.;Pratt, Robert H.;Armstrong, Lori R.
背景美国近五分之一的结核病病例是肺外结核;与肺结核病例的年度病例数减少相比，肺外结核（EPTB）的年度病例数减少速度较慢，原因不明。我们通过美国国家结核病监测数据描述了EPTB的流行病学。1993年至2006年报告的美国结核病病例被分类为EPTB或PTB。EPTB包括淋巴、胸膜、骨和/或关节、泌尿生殖系统、脑膜、腹膜和未分类的EPTB病例。我们排除了并发肺外肺结核和播散性（粟粒性）结核病例。比较EPTB和PTB病例的人口学特征、药物敏感性试验结果和危险因素，包括人类免疫缺陷病毒（HIV）状态。在253，299例中，73.6%为PTB，18.7%为EPTB，包括淋巴管（40.4%）、胸膜（19.8%）、骨和/或关节（11.3%）、泌尿生殖系统（6.5%）、脑膜（5.4%）、腹膜（4.9%）和未分类的EPTB（11.8%）。与PTB相比，EPTB与女性有关（比值比[OR]，1.7; 95%置信区间[CI]，1.7-1.8）和外国出生（OR，1.5; CI，1.5-1.6），与HIV状态几乎同样相关（OR，1.1; CI，1.1-1.1），与多药耐药呈负相关（OR，0.6; CI，0.5-0.6）和几个结核病风险因素，特别是无家可归（OR，0.3; CI，0.3-0.3）和过量饮酒（OR，0.3;与肺结核病例计数的年度减少相比，肺结核病例计数的年度减少较慢，1993 ~ 2006年的结核病发病率从1993年的15.7%上升到2006年的21.0%。EPTB的流行病学和危险因素与PTB不同，从1993年到2006年，EPTB的比例有所增加。需要进一步研究以确定EPTB比例增加的原因。
Background. Almost one-fifth of United States tuberculosis cases are extrapulmonary; unexplained slower annual case count decreases have occurred in extrapulmonary tuberculosis (EPTB), compared with annual case count decreases in pulmonary tuberculosis (PTB) cases. We describe the epidemiology of EPTB by means of US national tuberculosis surveillance data.Methods. US tuberculosis cases reported from 1993 to 2006 were classified as either EPTB or PTB. EPTB encompassed lymphatic, pleural, bone and/or joint, genitourinary, meningeal, peritoneal, and unclassified EPTB cases. We excluded cases with concurrent extrapulmonary-pulmonary tuberculosis and cases of disseminated (miliary) tuberculosis. Demographic characteristics, drug susceptibility test results, and risk factors, including human immunodeficiency virus (HIV) status, were compared for EPTB and PTB cases.Results. Among 253,299 cases, 73.6% were PTB and 18.7% were EPTB, including lymphatic (40.4%), pleural (19.8%), bone and/or joint (11.3%), genitourinary (6.5%), meningeal (5.4%), peritoneal (4.9%), and unclassified EPTB (11.8%) cases. Compared with PTB, EPTB was associated with female sex (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.7-1.8) and foreign birth (OR, 1.5; CI, 1.5-1.6), almost equally associated with HIV status (OR, 1.1; CI, 1.1-1.1), and negatively associated with multidrug resistance (OR, 0.6; CI, 0.5-0.6) and several tuberculosis risk factors, especially homelessness (OR, 0.3; CI, 0.3-0.3) and excess alcohol use (OR, 0.3; CI, 0.3-0.3).Slower annual decreases in EPTB case counts, compared with annual decreases in PTB case counts, from 1993 through 2006 have caused EPTB to increase from 15.7% of tuberculosis cases in 1993 to 21.0% in 2006.Conclusions. EPTB epidemiology and risk factors differ from those of PTB, and the proportion of EPTB has increased from 1993 through 2006. Further study is needed to identify causes of the proportional increase in EPTB.