Extrapulmonary tuberculosis in Pakistan- A nation-wide multicenter retrospective study
Extrapulmonary tuberculosis in Pakistan- A nation-wide multicenter retrospective study
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DOI：
10.1371/journal.pone.0232134
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发表时间：
2020-04-28
期刊：
影响因子：
3.7
通讯作者：
Mustafa, Tehmina
中科院分区：
文献类型：
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作者：
Tahseen, Sabira;Khanzada, Faisal Masood;Mustafa, Tehmina
背景巴基斯坦在结核病高负担国家中排名第五。肺外结核病 (EPTB) 呈稳步上升趋势，目前占所有通报结核病病例的 20%。关于 EPTB 流行病学的信息非常有限。本研究的目的是描述巴基斯坦 EPTB 患者的人口特征、临床表现和治疗结果。方法我们对 2016 年在全国范围内登记的结核病患者队列的常规收集数据进行了描述性分析，这些数据是在使用分层方便抽样选择的卫生机构选择的。结果 2016 年在 50 个研究地点登记了总共 54092 名结核病患者，其中包括 15790 例 (29.2%) EPTB 病例。 EPTB 患者的中位年龄为 24 岁，PTB 患者的中位年龄为 30 岁。女性 EPTB 的粗患病率为 30.5% (95% CI; 29.9-31.0)，而男性为 27.9% (95% CI; 27.3-28.4)。患有 EPTB (OR) 的可能性，女性是 1.1 倍，儿童是 2.0 倍，西北省份居民是 3.3 倍。最常见的 EPTB 形式是胸膜结核 (29.6%)、淋巴结核 (22.7%) 和腹部结核 (21.0%)。胸膜结核是成人最常见的临床表现（34.2%），腹部结核是儿童最常见的临床表现（38.4%）。随着年龄的增长，胸膜和骨关节结核的患病率增加，而淋巴和腹部结核的患病率下降。各省之间的人口统计学和临床表现存在差异。与细菌学证实的 PTB 相比，所有类型 EPTB 的治疗成功率均显着较高，但影响 CNS 且死亡率较高的 EPTB 除外。结论该研究提供了对 EPTB 的人口统计学、临床表现和治疗结果的深入了解。需要进一步研究来解释各省之间观察到的显着差异、EPTB 管理的具体风险因素和挑战。
BackgroundPakistan is fifth among high burden countries for tuberculosis. A steady increase is seen in extrapulmonary tuberculosis (EPTB), which now accounts for 20% of all notified TB cases. There is very limited information on the epidemiology of EPTB. This study was performed with the aim to describe the demographic characteristics, clinical manifestations and treatment outcomes of EPTB patients in Pakistan.MethodWe performed descriptive analysis on routinely collected data for cohorts of TB patients registered nationwide in 2016 at health facilities selected using stratified convenient sampling.FindingsAltogether 54092 TB including 15790 (29.2%) EPTB cases were registered in 2016 at 50 study sites. The median age was 24 years for EPTB and 30 years for PTB patients. The crude prevalence of EPTB in females was 30.5% (95%CI; 29.9-31.0) compared to 27.9% (95%CI; 27.3-28.4) in males. The likelihood of having EPTB (OR), was 1.1 times greater for females, 2.0 times for children, and 3.3 times for residents of provinces in the North-West.The most common forms of EPTB were pleural (29.6%), lymphatic (22.7%) and abdominal TB (21.0%). Pleural TB was the most common clinical manifestation in adults (34.2%) and abdominal TB in children (38.4%). An increase in the prevalence of pleural and osteoarticular and decline in lymphatic and abdominal TB was observed with advancing age. Diversity in demography and clinical manifestations were noted between provinces. The treatment success rate for all type EPTB was significantly high compared to bacteriology confirmed PTB with the exception of EPTB affecting CNS with a high mortality rate.ConclusionsThe study provides an insight into demography, clinical manifestations and treatment outcomes of EPTB. Further studies are needed to explain significant diversities observed between provinces, specific risk factors and challenges concerning EPTB management.