Rare Extrapulmonary Tuberculosis in Immunocompetent Adults: Experience of a Tertiary Hospital

Abstract

Objective: Tuberculosis (TB) is an infection that can involve all tissues and organs. Although pulmonary TB (PTB) is more common, extrapulmonary TB (EPTB) is still a major clinical problem. The incidence of EPTB is 35.1% and in recent years; there has been an increase in EPTB case reporting in our country. In this study, we retrospectively investigated the clinical and laboratory characteristics of rare EPTB cases. Methods: The study included rare EPTB patients diagnosed and/or followed up in our clinic. Cases with pleural TB and lymph node TB were excluded from the study. The diagnosis of EPTB was made by clinical, microbiological and/or histopathological and/or radiological findings and response to treatment. The demographic features, clinical findings and laboratory values were recorded from patient files, and were evaluated in terms of EPTB. Results: Fifty patients were included in the study (mean age=34±15.8 years, female/male=33/17). The most frequently involved organ was peritoneum (n=13, 26%). There was multi-organ involvement in 4 cases (8%). Coexistence of EPTB with PTB was determined in 9 cases (18%). Four patients had a history of TB and 14 had a history of contact with TB. All the cases were human immunodeficiency virus-negative, and one case was hepatitis B surface antigen positive. The major complaints were abdominal pain, weight loss, night sweats, fever, and cough. Twenty-three patients had normal chest radiographs and the mean duration of treatment was 9 months. Conclusion: TB is a serious public health problem in Turkey as well as all over the world. Since it is a treatable disease, early diagnosis and treatment have utmost importance for avoiding the serious complications of rare EPTB forms.

Three Rare Cases of Otolaryngology Tuberculosis: A Report of Extra-Pulmonary Tuberculosis Cases in the Larynx, Tonsil and Parotid

“…EPTB may involve any organ due to lymphohematogenous dissemination of the primary infection, with lymph nodes and pleura being the common site of EPTB. Furthermore, the upper airway, tonsils, and parotid are rare sites of EPTB infection [3,4].…”

“…Due to its different clinical courses in different organs and mimicry of other diseases such as neoplasms causes difficulties in establishing the EPTB diagnosis. Furthermore, EPTB in the locations such as larynx, tonsils, and the parotid glands, are a rare entity where it only makes up 2 -4% of EPTB cases [4]. Early diagnostic tools utilise radiological examination including USG, CT and MRI; however, this leads to less specific results [9].…”

Ekstrapulmoner tüberküloz olgularının epidemiyolojik profili: 4 yıllık deneyim

“…At the same, due to the retrospective nature of the study, it was not possible to show detailed clinical properties of the EPTB patients, which might play a notable role in indicating the overall profile of the patients. Smokers, alcoholics, previous contact with EPTB, hypertension, chronic obstructive pulmonary disease and underlying disease (cancer, etc) patients have an advanced incidence of EPTB in many studies 6,13,32 .…”

“…Its incidence varied from 8% in the Western Pacific Region to 24% in the Eastern Mediterranean Region 2 . The incidence of EPTB has been reported to be 30-45% in Turkey 6 .…”

“…EPTB emerges as a result of lympho-hematogenous spreading of the primary infection and subsequent latency of the spreading TB bacilli, which may then reactivate in the event of increased susceptibility or reduced body resistance. The disease might appear in any stage of life and may affect any organ 6 . 6.3 million new cases of TB were officially recognized by WHO in 2017, 16% of which were cases of EPTB.…”