Extrapulmonary tuberculosis in Pakistan- A nation-wide multicenter retrospective study

Tahseen, Sabira; Khanzada, Faisal Masood; Baloch, Aurangzaib Quadir; Abbas, Qasim; Bhutto, Mansoor Manzoor; Alizai, Ahmad Wali; Shah, Zaman; Qasim, Zahida; Durrani, Muhammad Najeeb; Farough, M. Khalid; Ambreen, Atiqa; Safdar, Nauman; Mustafa, Tehmina

doi:10.1371/journal.pone.0232134

Cited by 47 publications

(76 citation statements)

References 24 publications

(44 reference statements)

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“…Mycobacteria culture is the gold standard for definitive diagnostic [7] but it has been used mainly for research purposes and avail in drug resistance TB treatment center in our country. Consistent with studies in other developing countries (0.5%-19.20%) [48,50,56], we found that only 1.5% had AFB positive results. In contrast, EPTB cases were bacteriology confirmed in 58-76% [57][58][59] in developed countries.…”

Section: Discussionsupporting

confidence: 92%

“…A slightly higher proportion, 51.4% (57) of ATB occurred among females. The documented presenting symptoms included weight loss, 50.5% (56), loss of appetite,43.2%, (48), fever, 37.8% (42), abdominal pain,36.9% (44), night sweating, 32.4% (36), and abdominal distension,18.9% (21). Among ATB with peritonitis,62 had a documented fluid analysis result.…”

Section: Plos Onementioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Plos Onementioning

confidence: 99%

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

et al. 2020

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“…CNS involvement is a relatively rare presentation of tuberculosis as compared to other sites of extrapulmonary TB [ 1 ]. It is the gravest systemic presentation of TB due to the increased mortality rate, with regular neurological complications and permanent deficits [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Central nervous system (CNS) involvement accounts for 4.6% of extrapulmonary TB cases in Pakistan. CNS TB has a treatment success rate of 74.3% in Pakistan [ 1 ] which is relatively low as compared to other forms of TB. Therefore it is prudent to detect and treat on time in order to obtain better outcomes.…”

Section: Introductionmentioning

confidence: 99%

Central Nervous System Tuberculosis With Shower Like Pattern of Intracranial Tuberculomas in an Immunocompetent Patient

Arif¹,

Arif²,

Slehria³

et al. 2020

Cureus

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Central nervous system tuberculosis (CNS TB), though comparatively uncommon as compared to other forms of extrapulmonary tuberculosis (TB), results in high morbidity and mortality. The symptoms are non-specific and of a progressive nature resulting in delayed diagnosis. We present a case of CNS TB that presented two months after the onset of symptoms. The patient’s condition reached the point of being bedbound. On investigation, the widespread involvement of the brain with shower-like pattern of ring enhancing tuberculomas and associated tuberculous meningitis was found. This was a surprising finding considering the patient was immunocompetent. Contrast-enhanced magnetic resonance imaging showed lesions in midbrain, pons, medulla, thalamus, bilateral cerebellar hemispheres and bilateral cerebral hemispheres. Upon treatment initiation the patient responded well with resolution of all lesions.

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“…Extrapulmonary tuberculosis (EPTB) can have central nervous system and pleural manifestations as well as gastrointestinal and lymph node involvement. It is one of the top differentials in a patient with pyrexia of unknown origin (PUO) along with gastrointestinal and nodal involvement in an endemic region like Pakistan [1,2]. On the other hand, Castleman disease (CD) is a rare condition [3], characterized by non-clonal lymphoid proliferation.…”

Section: Introductionmentioning

confidence: 99%

A Case of Castleman Disease: A Diagnostic Dilemma

Anwar

Mehr

Tahir

et al. 2021

Cureus

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Castleman disease (CD) is a disorder characterized by lymphoid proliferation. It is not usually the first differential for pyrexia of unknown origin (PUO) because of the extremely rare incidence worldwide. We report the case of a 24-year-old man with PUO for six months. He had been previously investigated for infective, rheumatological, and immunological causes. Extrapulmonary tuberculosis was considered as the most likely diagnosis because of his clinical presentation and locality. Based on this, he was given a trial of anti-tuberculous therapy. However, he did not show any signs of improvement despite being compliant with the medications. His condition was further complicated by the development of ascites. Upon treatment failure, the patient presented to our tertiary care hospital and was investigated for a possible revision of diagnosis. Based on clinical assessment and histopathology of the lymph nodes, he was diagnosed with idiopathic multicentric CD overlapping with systemic lupus erythematosus. He was started on azathioprine and prednisone and showed a positive response, indicated by a decreasing erythrocyte sedimentation rate and C-reactive protein. The patient continues to be healthy and in remission to date.

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Extrapulmonary tuberculosis in Pakistan- A nation-wide multicenter retrospective study

Cited by 47 publications

References 24 publications

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

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

Central Nervous System Tuberculosis With Shower Like Pattern of Intracranial Tuberculomas in an Immunocompetent Patient

A Case of Castleman Disease: A Diagnostic Dilemma

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