Evaluation of treatment response in extrapulmonary tuberculosis in a low-resource setting

Abstract

Background Diagnosing extrapulmonary tuberculosis (EPTB) is challenging and many patients are initiated on empirical anti-TB treatment without a laboratory confirmed diagnosis. Monitoring treatment response is thus important to ensure correct diagnosis and proper disease management. The definition of satisfactory response to treatment in EPTB remains unclear. The objectives of this study were to describe the clinical presentation of EPTB and the effect of treatment on clinical parameters. Further, to assess if simple clinical parameters, without laboratory data, could evaluate treatment response. Methods Prospective cohort study of presumptive EPTB patients at Mnazi Mmoja Hospital, Zanzibar. By using a composite reference standard, patients were categorized as TB or non-TB cases. The TB patients were followed during anti-TB treatment. Results There were 64 TB and 62 non-TB cases. The frequency of symptoms at baseline were comparable in TB and non-TB patients, with lymphadenitis and pleuritis as the most common manifestations. Among TB cases, there was a trend towards regression of lymphadenopathy after 2 months, and at treatment completion 24/28 (86%) cases showed full regression. Weight gain ≥5% was reported in 36/49 (73%) of the TB patients at 2 months and in 38/46 (83%) at treatment completion. After 2 months of treatment, a combination of clinical parameters; improvement of symptoms (50/50), ≥5% weight gain (36/49) and regression of physical signs (45/49) correlated with the treatment response. Conclusions An algorithm including only simple clinical parameters could be used as an easy tool to assess treatment responses in low-resource settings. However, this needs to be tested on a larger sample size.

Clinical features of tuberculous lymphadenitis in a low-incidence country

“…An elevated erythrocyte sedimentation rate was seen in 74% of the current cohort. Clinical parameters such as weight gain, improvement of symptoms, and regression of clinical signs may be particularly useful in assessing treatment success in EPTB patients (Jørstad et al, 2019).…”

Estado nutricional e perfil sociodemográfico de pacientes com tuberculose pulmonar / Nutritional status and sociodemographic profile of patients with pulmonary tuberculosis

“…Houve aumento significativo entre a média de peso inicial e final dos pacientes no decorrer da terapia anti-TB (p 0,000). Evidencias de ganho de peso durante o tratamento também foram descritas em 73% dos pacientes que participaram de um estudo realizado na Tanzânia, que avaliou a resposta ao tratamento anti-TB extrapulmonar em um cenário de baixa renda (35) . Durante a infecção ativa por TB há o aumento da demanda energética individual causada pela elevação da produção de citocinas proteolíticas e lipolíticas, isto leva à perda de peso acentuada devido a maior demanda metabólica basal (36) .…”

Extrapulmonary tuberculosis

“…The diagnosis of extrapulmonary tuberculosis is a challenge and many patients start an empirical treatment against tuberculosis without a laboratory-confirmed diagnosis. Therefore, controlling the response to treatment is important to ensure a correct diagnosis and proper management of the disease, yet the definition of a satisfactory response to treatment in extrapulmonary tuberculosis remains unclear 35 .…”