The prevalence of concurrent pulmonary and extrapulmonary tuberculosis in Uganda: a retrospective study

Abstract

Background: Concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) is associated with poor treatment outcomes yet its epidemiology in Uganda is unknown. The purpose of this study was to determine the prevalence, associated factors, and treatment outcomes of concurrent PTB and EPTB among patients at a national tuberculosis (TB) treatment center located at Mulago National Referral Hospital in Kampala, Uganda. Methods: We conducted a retrospective review of charts for people with TB who were enrolled in care between January 2015 and December 2019. Eligible charts were for people with pulmonary bacteriologically confirmed TB enrolled into care in the period under study. Concurrent PTB and EPTB was defined as PTB and bacteriological, histopathological, and/or radiological features of TB at another noncontiguous sites. Results: Overall, 400 patient charts were eligible, of whom 240 (60.0%) were aged 15–34 years and 205 (51.3%) were female. The prevalence of concurrent PTB and EPTB was 8.5% (34/400) [95% confidence interval (CI): 6.0–11.7%]. People with concurrent PTB and EPTB were more likely to have at least one comorbidity (82.4% versus 37.2%, p < 0.001), of which HIV was the most frequent. Furthermore, people with concurrent PTB and EPTB were more likely to have empyema (15% versus 2.6%, p = 0.028) but less likely to have bronchopneumonic opacification (0.0% versus 15.3%, p = 0.043) on chest x-ray imaging. People with concurrent PTB and EPTB had higher mortality (26.5% versus 6.37%) and a lower cure rate (41.2% versus 64.8%), p = 0.002. Conclusion: Our findings highlight the need for early detection of TB before dissemination particularly among people who use alcohol and people with HIV.

Chronic multifocal tubercular osteomyelitis in a young Nepalese boy: A rare case presentation

“…The caseous exudative type is characterized by bone destruction, local swelling, abscess formation, sinus formation, and constitutional symptoms. This type is mostly seen in children [13] . The granular type is more insidious, less destructive, and more common in adults [13] .…”

“…This type is mostly seen in children [13] . The granular type is more insidious, less destructive, and more common in adults [13] . However, the pattern of disease seen in TB is dynamic and often has mixed patterns.…”

Sobrevida en una cohorte con diagnóstico de tuberculosis en Colombia

“…Banta et al,describieron 258.631 pacientes con TB pulmonar y extrapulmonar, reportando hospitalizaciones más prolongadas y costosas en la TB extrapulmonar, sin presentar diferencia en las tasas de mortalidad al compararse con la TB pulmonar (Banta et al,2020); la TB extrapulmonar se presentó en el 22,3%, siendo la más frecuente en huesos y articulaciones, TB miliar y meníngea. Las diferencias descritas en la literatura en la carga de estancia hospitalaria y costos, se podría relacionar con un diagnóstico temprano, prevención primaria y tratamiento oportuno en los casos de la infección pulmonar, frente a los desafíos en el diagnóstico en estadios tempranos y asintomáticos de la TB extrapulmonares (Banta et al, 2020;Kyagulanyi et al, 2022). Si bien nuestro estudio no buscó describir las características sobre la mortalidad en relación a la ubicación anatómica de la infección por el MT, la TB pulmonar fue más frecuente en los pacientes fallecidos, seguido de la TB pleural, meníngea y osteoarticular.…”