National Profile and Treatment Outcomes of Patients with Extrapulmonary Tuberculosis in Bénin

Abstract

BackgroundIn sub-Saharan Africa, there is a dearth of published literature on extrapulmonary tuberculosis (EPTB).ObjectiveTo describe demographic, diagnostic and HIV-status characteristics of patients with EPTB in Bénin, their treatment outcomes, and among those who completed their treatment in the Centre National Hospitalier de Pneumo-Phtisiologie (CNHP-P), the proportion whose bodyweight increased during treatment.Material and FindingsThis was a retrospective cohort study with comparisons made between EPTB and new smear-positive pulmonary tuberculosis (NPTB) patients diagnosed in the country from January to December 2011. There were 383 EPTB patients (9% of all TB cases) with a mean age of 35 years, male/female ratio of 1.3 and important regional variation. There were significantly more females (p = 0.001), children <15years (p<0.001) and HIV-positive patients (p = 0.005) with EPTB compared with NPTB. Pleural effusion, spinal and lymph node tuberculosis accounted for 66% of all EPTB. Children <15 years represented 16% of cases, with lymph node disease being most common among them (p<0.001). Of 130 EPTB patients registered in CNHP-P, 7% had a confirmed bacteriological/histological diagnosis. There were 331 (86%) patients who successfully completed treatment. More patients with EPTB were lost-to-follow-up compared with NPTB (p<0.001) with all these patients from one region. The best treatment completion rates were in children <15 years (OR:3.5, 95%CI:1.0–14.8) while patients with pleural effusion and ascites had the worst outcomes. Of 72 HIV-coinfected patients, 88% were on antiretroviral therapy (ART). HIV-positive status was associated with poor outcomes while those on ART fared better. In the CNHP-P, more than 80% who completed their treatment showed an increase in bodyweight and this was more evident in HIV-positive compared with HIV-negative patients (p = 0.03).ConclusionPatients with EPTB generally do well in Bénin, although the TB Programme would benefit through more attention to accurate diagnosis and earlier start of ART in HIV-infected patients.

Profile and treatment outcomes of patients with tuberculosis in Northeastern Ethiopia: A cross sectional study

“…Majority, at 22.3% and 30% of TB patients were in the age groups of 15-24 and 25-34 years respectively. This report is also in line with other literatures 5,10,[14][15] which indicated that, TB mainly affects the reproductive segment of the population. This might be due to high HIV prevalence in these age groups (personal opinion).…”

Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study

“…The higher success rate in HIV-positive patients are not consistent with what is usually observed in the TB drug susceptible population, where success rates are lower among HIV-positive due to higher death rate [15]. We also report a high case fatality rate among HIV-positive patients for both MDR and PDR-TB patients, likely to be attributable to HIV as already shown in previous studies [16][17][18]. Despite the higher proportion of rifampicin resistant PDR-TB among HIV-positive patients, the failure rate of PDR-TB treatment was similar between HIV-positive and negative patients.…”

Risk Factors for Extra Pulmonary Tuberculosis in the Health District of Thies, Senegal

“…With the occurrence of Human Immunodeficiency Virus (HIV) infection, TB is increasing either in developing than developed countries. ExtraPulmonary Tuberculosis (EPTB) characterized by the development of TB outside the lungs is also increasing in term of frequency worldwide [1][2][3][4][5][6][7][8]. However, clinical presentations are various and delaying the diagnosis.…”

“…The other factor could be physician-based because of absence or delay in the screening of TB among patients. This could be related to lack of training, poor knowledge on the disease and lack of lab equipment in the African continent [1]. In another view, sometimes, treatment is proposed empirically based on clinical and radiological arguments.…”

“…In another view, sometimes, treatment is proposed empirically based on clinical and radiological arguments. Studies conducted worldwide have identified several risk factors associated with the occurrence of EPTB: age [1,2,9], female sex [1,11,12], no vaccination [13], contact with TB patient [5,12,14], alcohol consumption [11,15], employment [13,16], diabetes [15] and HIV infection [1,11] particularly. Senegal, like many Sub-Saharan African countries, is facing the TB epidemics.…”