Cancer obscures extrapulmonary tuberculosis (EPTB) at a tertiary hospital in Northern Malawi

Abstract

Data on the prevalence of extrapulmonary tuberculosis (EPTB) patients are limited in many African countries including Malawi. We conducted a retrospective review of all histology reports for cancer suspected patients at Mzuzu Central Hospital (MZCH) between 2013 and 2018 to determine the proportion of EPTB cases among cancer suspected patients and characterised them epidemiologically. All reports with inconclusive findings were excluded. In total, 2214 reports were included in the review, 47 of which reported EPTB, representing 2.1% (95% CI 1.6−2.8). The incidence of EPTB was significantly associated with sex, age and HIV status. Men were more than twice (OR 2.1; 95% CI 1.2–3.9) as likely to have EPTB as women while those with HIV were more than six times (OR 6.4; 95% CI 1.7–24.8) as likely to have EPTB compared to those who were HIV-negative. EPTB demonstrated an inverse relationship with age. The highest proportion of EPTB was found from neck lymph nodes (10.3% (5.4–17.2)). A reasonable number of EPTB cases are diagnosed late or missed in Malawi's hospitals. There is a need for concerted efforts to increase EPTB awareness and likely come up with a policy to consider EPTB as a differential diagnosis in cancer suspected patients.

Epidemiology, Drug Resistance Patterns, Treatment Outcomes, and Predictors of Death among Mycobacterium tuberculosis patients in Northern Malawi

“…Nevertheless, the greatest burden is observed among adult males (aged ≥ 15 years), with a global estimate of 5.8 million cases (95% UI: 5.4-6.2 million) in 2022, constituting approximately 55% of the total estimated cases (5). Furthermore, a high burden of tuberculosis has been associated with individuals living with HIV, various occupations, geographical locations, socioeconomic factors, and numerous other determinants (5,4,7,8,6,9,2,3,10). The severity of national tuberculosis epidemics varies signi cantly across countries, ranging from fewer than 10 to more than 500 cases (5).…”

Epidemiology, Drug Resistance Patterns, Treatment Outcomes, and Predictors of Death among Mycobacterium tuberculosis patients in Northern Malawi

“…Nevertheless, the greatest burden is observed among adult males (aged ≥ 15 years), with a global estimate of 5.8 million cases (95% UI: 5.4-6.2 million) in 2022, constituting approximately 55% of the total estimated cases (5). Furthermore, a high burden of tuberculosis has been associated with individuals living with HIV, various occupations, geographical locations, socioeconomic factors, and numerous other determinants (5,4,7,8,6,9,2,3,10). The severity of national tuberculosis epidemics varies signi cantly across countries, ranging from fewer than 10 to more than 500 cases (5).…”

Prevalence of extra‐pulmonary tuberculosis in Africa: A systematic review and meta‐analysis

“…TB prevalence surveys conducted by various countries per WHO's recommendations focus on bacteriologically confirmed PTB only, not EPTB [18]. Data on the prevalence of EPTB in African countries is lacking [19]. This study aims to determine the prevalence of EPTB in African countries by performing a systematic review and meta-analysis.…”

Programmatic Challenges in Managing Multidrug-Resistant Tuberculosis in Malawi

“…Malawi, being a resource-constrained country, is also facing similar challenges evidenced in the burden of TB and MDR-TB. [ 15 – 17 ] An increase in MDR-TB cases and poor treatment outcomes presents a formidable challenge to TB control that will lead to failure in achieving the end TB strategy. Therefore, it is the main objective of this paper to explore the programmatic challenges that Malawi NTP is facing in managing MDR-TB.…”

Epidemiology, Drug Resistance Patterns, Treatment Outcomes, and Predictors of Death among Mycobacterium tuberculosis patients in Northern Malawi

“…Nevertheless, the greatest burden is observed among adult males (aged ≥ 15 years), with a global estimate of 5.8 million cases (95% UI: 5.4-6.2 million) in 2022, constituting approximately 55% of the total estimated cases (5). Furthermore, a high burden of tuberculosis has been associated with individuals living with HIV, various occupations, geographical locations, socioeconomic factors, and numerous other determinants (5,4,7,8,6,9,2,3,10). The severity of national tuberculosis epidemics varies signi cantly across countries, ranging from fewer than 10 to more than 500 cases (5).…”

Prevalence of extra‐pulmonary tuberculosis in Africa: A systematic review and meta‐analysis

“…TB prevalence surveys conducted by various countries per WHO's recommendations focus on bacteriologically confirmed PTB only, not EPTB [18]. Data on the prevalence of EPTB in African countries is lacking [19]. This study aims to determine the prevalence of EPTB in African countries by performing a systematic review and meta-analysis.…”

Programmatic Challenges in Managing Multidrug-Resistant Tuberculosis in Malawi

“…Malawi, being a resource-constrained country, is also facing similar challenges evidenced in the burden of TB and MDR-TB. [ 15 – 17 ] An increase in MDR-TB cases and poor treatment outcomes presents a formidable challenge to TB control that will lead to failure in achieving the end TB strategy. Therefore, it is the main objective of this paper to explore the programmatic challenges that Malawi NTP is facing in managing MDR-TB.…”

Epidemiology, Drug Resistance Patterns, Treatment Outcomes, and Predictors of Death among Mycobacterium tuberculosis patients in Northern Malawi

“…Nevertheless, the greatest burden is observed among adult males (aged ≥ 15 years), with a global estimate of 5.8 million cases (95% UI: 5.4-6.2 million) in 2022, constituting approximately 55% of the total estimated cases (5). Furthermore, a high burden of tuberculosis has been associated with individuals living with HIV, various occupations, geographical locations, socioeconomic factors, and numerous other determinants (5,4,7,8,6,9,2,3,10). The severity of national tuberculosis epidemics varies signi cantly across countries, ranging from fewer than 10 to more than 500 cases (5).…”

Prevalence of extra‐pulmonary tuberculosis in Africa: A systematic review and meta‐analysis

“…TB prevalence surveys conducted by various countries per WHO's recommendations focus on bacteriologically confirmed PTB only, not EPTB [18]. Data on the prevalence of EPTB in African countries is lacking [19]. This study aims to determine the prevalence of EPTB in African countries by performing a systematic review and meta-analysis.…”

Programmatic Challenges in Managing Multidrug-Resistant Tuberculosis in Malawi

“…Malawi, being a resource-constrained country, is also facing similar challenges evidenced in the burden of TB and MDR-TB. [ 15 – 17 ] An increase in MDR-TB cases and poor treatment outcomes presents a formidable challenge to TB control that will lead to failure in achieving the end TB strategy. Therefore, it is the main objective of this paper to explore the programmatic challenges that Malawi NTP is facing in managing MDR-TB.…”