Epidemiology and the diagnostic challenge of extra-pulmonary tuberculosis in a teaching hospital in Ethiopia

Abstract

Background Ethiopia reported a high rate of extra-pulmonary tuberculosis (EPTB) and the cases are increasing since the last three decades. However, diagnostic evidence to initiate TB treatment among EPTB cases is not well known. Therefore, we described the epidemiology and assessed how EPTB is diagnosed in a teaching hospital in Ethiopia. Methods We conducted a retrospective review among all adult EPTB cases diagnosed in Yekatit 12 Hospital Medical College from 2015 to 2019. Using a standardized data abstraction sheet, we collected data from patients’ medical records on sociodemographic, sites, and laboratory diagnosis of EPTB cases. Results Of the 965 total TB cases, 49.8%(481) had a recorded diagnosis of EPTB during the study period. The mean age of EPTB patients was 32.9 years (SD±13.9) and 50.7% were males. Tubercular lymphadenitis (40.3%), abdominal (23.4%), and pleural TB(13.5%) were the most common sites of EPTB involvement, followed in descending order by the genitourinary, skeletal, central nervous system, abscess, breast, and laryngeal TB. We found a histopathology finding consistent with EPTB in 59.1% of cases, Acid-fast bacilli positive in 1.5%, and the rest diagnosed on radiological grounds. In the majority of cases, more than one diagnostic method was used to diagnose EPTB cases. Conclusions Nearly half of TB patients had a recorded diagnosis of EPTB that comprise heterogeneous anatomical sites. All EPTB patients were started anti-TB therapy without definitive microbiology results. This indicates the diagnostic challenge of EPTB faced in our setting and proves to be significant for TB control in Ethiopia.

A Rare Case of Multidrug-Resistant Tuberculosis Affecting the Pleura

“…Even though our patients' HIV testing was negative, all patients with extra-pulmonary TB should be screened for HIV infection because positive HIV status has been linked to increased risk of both DS- and DR-TB [ 10 ]. Furthermore, in the case of EP-TB infections, where the diagnosis may be based solely on clinical and early laboratory results without final microbiological confirmation, a higher index of suspicion is usually required [ 11 ]. Diagnosis of any form of tuberculosis, particularly extra-pulmonary DR-TB, can be difficult for physicians at times.…”

Tuberculosis epidemiological trend in Sousse, Tunisia during twenty years (2000–2019)

“…The predominant extra-pulmonary sites were lymph nodes, pleura, and digestive system. This increase in extra-pulmonary cases could be the results of a multitude and complex risk factors such as immunological factors (HIV infection), socio-demographic factors (female sex, younger age, and non-white race) comorbidities, and lifestyle behaviors (diabetes, liver diseases, and consumption of unpasteurized raw milk) and genetic factors [ 33–38 ] and also the evolution and amelioration of diagnostic tools [ 39 ]. Worldwide, out of the 6.3 million new cases of tuberculosis recognized in 2017, 16% were extra-pulmonary with an incidence rate ranging from 8% in the Western Pacific Region to 24% in the Eastern Mediterranean Region [ 24 ].…”

“…Worldwide, out of the 6.3 million new cases of tuberculosis recognized in 2017, 16% were extra-pulmonary with an incidence rate ranging from 8% in the Western Pacific Region to 24% in the Eastern Mediterranean Region [ 24 ]. Extra-pulmonary cases represented 20% of all tuberculosis cases in Korea [ 40 ], 33% in China [ 24 ], 49% in both Morocco and Ethiopia [ 37 , 39 ] and reached 51% in India [ 41 ]. In the European Union and the European Economic Area, more than 150,000 cases of extra-pulmonary tuberculosis were declared in the 30 member states from 2002 to 2011 which accounted for 19.3% of all cases [ 42 ].…”

Abdominal Tuberculosis – A Resemblance to Peritoneal Carcinomatosis

“…Extra-pulmonary tuberculosis involves the abdomen in 11% of patients [3,4]. In various parts of Sub Saharan Africa, abdominal tuberculosis continues to be reported particularly from Sudan [5], Nigeria [6], Kenya [7] and Ethiopia [8]. Abdominal TB can prove to be a diagnostic challenge as it may present with nonspecific vague symptoms mimicking other common intra-abdominal pathological conditions [9,10].…”