Retrospective analysis of extrapulmonary tuberculosis a cross sectional study from a medical college, Chitwan, Nepal
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Abstract
Background
Extrapulmonary tuberculosis (EPTB) is an important clinical problem which can cause various complications and lifelong disabilities. Various sites of the body can be affected by EPTB. The aim of this study was to find out the common sites of EPTB, in different organ systems and to assess the pattern of disease correlating age and gender among the patients of Chitwan, Nepal.
Methods
This study was carried out on 89 cases of EPTB, diagnosed in Pathology Department of Chitwan Medical College Teaching in biopsy specimens from April 2009 to March 2011. All the cases of EPTB were divided into two major groups, depending on the involvement of lymph node.
Results
Lymph nodes were common sites (42%) of EPTB, and 43% cases cervical lymph nodes involved. Females were more prone for lymph node tuberculosis. Among males, cervical, inguinal lymph node infections were more. Axillary and supraclavicular regions were affected more in females. Majority of the lymph node infections were observed in the age group below 20 years. Axillary lymph node involvement was only observed in 20-40 years of age group; same as supraclavicular lymph node infection in >40 age group.
Conclusion
EPTB can occur in various parts of the body and lymph nodes are most common sites. Cervical lymph node infections were commonly observed. Most of the cases are seen in 2nd to 4th decades. Clinical presentation changes, depending to site of infection in exterapulmonary tuberculosis, so biopsy with histopathological exanimation may play significant role in diagnosis.
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References
Sudre P, Tendam G, Kochi A.Tuberculosis: a global overview of the situation today. Bull World Health Organ.1992;70(2):149-59.
Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF et al. Identification of risk factors of extrapulmonary tuberculosis. Clin Infect Dis. 2004; 38(2):199-205.
Noertjojo K, Tam CM, Chan SL, Chan-Yeung MM. Extra-pulmonary and pulmonary tuberculosis in Hong Kong. Int J Tuberc Lung Dis. 2002;6(10):879-86.
Musellim B, Erturan S, Sonmez Duman E, Ongen G. Comparison of extrapulmonary and pulmonary tuberculosis cases: factors influencing the site of reactivation. Int J Tuberc Lung Dis. 2005;9(11): 1220-3.
Ilgazli A, Boyaci H, Basyigit I, Yildiz F.Extra pulmonary tuberculosis: clinical and epidemiologic spectrum of 636 cases. Arch Med Res 2004, 35(5):435-41.
Sharma SK, Mohan A.Extrapulmonary tuberculosis.Indian J Med Res. 2004;120(4):316-53.
Shafer RW, Kim DS, Weiss JP, Quale JM. Extrapulmonary tuberculosis in patients with human immunodeficiency virus infection. Medicine (Baltimore) 1991;70(6):384-97.
Mert A, Tabak F, Ozaras R, Tahan V, Ozturk R, Aktuglu Y. Tuberculous lymphadenopathy in adults: a review of 35 cases. Acta Chir Belg 2002;102(2):118-21.
Ebdrup L, Storgaard M, Jensen-Fangel S, Obel N. Ten years of extrapulmonary tuberculosis in a Danish university clinic. Scand J Infect Dis 2003;35(4):244-6.
Jha BC, Dass A, Nagarkar NM, Gupta R, Singhal S. Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management. Postgrad Med J. 2001;77(905):185-7.
American Thoracic Society, CDC. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000;161(4 pt 1):1376-95.
Artenstein AW, Kim JH, Williams WJ, Chung RC. Isolated peripheral tuberculous lymphadenitis in adults: current clinical and diagnostic issues. Clin Infect Dis 1995;20(4):876-82.
Frankel A, Penrose C, Emer J. Cutaneous Tuberculosis.J Clin Aesthet Dermatol.2009;2(10): 19–27.
Gaude GS, Reyas AK. Tuberculosis of the chest wall without pulmonary involvement. Lung India.2008; 25(3): 135–7.
Grosskopf I, Ben David A, Charach G, Hochman I, Pitlik S. Bone and joint tuberculosis-a 10-year review. Isr J Med Sci. 1994;30(4):278-83.
Watts HG, Lifeso RM. Tuberculosis of bones and joints. J Bone Joint Surg Am 1996;78(2):288-98.
Lifeso RM, Weaver P, Harder EH. Tuberculous spondylitis in adults. J Bone Joint Surg Am 1985;67(9):1405-13.
Molodtsov VG, Biriukova LA, Shipkov AV, Dobzhanskiĭ AV. A case of extrapulmonary tuberculosis with laryngeal and intestinal involvement. Vestn Otorinolaringol. 2001;(4):57.
P J Gupta. Ano-perianal tuberculosis - solving a clinical dilemma. Afr Health Sci. Dec 2005; 5(4): 345–7.
Seibert AF, Haynes J Jr, Middleton R, Bass JB Jr. Tuberculous pleural effusion. Twenty-year experience. Chest 1991;99(4):883-6.
Baharoon S. Tuberculosis of the breast. Ann Thorac Med. 2008;3(3):110–14.
Bhargava A, Davenport C, Gibbons N, McConkey S. TB or not TB?: a case of isolated testicular TB with scrotal involvement. Ir J Med Sci. 2009;178(2):231-3.
Golden MP. Extrapulmonary Tuberculosis: An Overview. Am Fam Physician. 2005;72(9):1761-8.
Global Tuberculosis Report 2014, WHO. Accessed on 12-12-2014 from URL:http://apps.who.int/iris/bitstream/10665/137094/1/9789241564809_eng.pdf?ua=1
Tuberculosis Control SAARC Region Update 2013. SAARC Tuberculosis and HIV/AIDS Centre. Kathmandu, Nepal. Accessed on 12-12-2014 from URL:http://www.saarctb.org/attachments/article/23/TB%20update%202013.pdf
Central TB Division. 2010. TB India 2010: RNTCP status report. Ministry of Health and Family Welfare, New Delhi, India. Accessed on 12-12-2014 from URL: http://tbcindia.nic.in/pdfs/TB%20India%202010.pdf
Rijal B, Ghimire P, Tuladhar NR. Comparison of Acid Fast Bacilli Smear and Culture for the Diagnosis of Extra-Pulmonary Tuberculosis. Journal of Nepal Medical Association.2004;43(155):235-8.
Srivastava GN, Meena M, Yadav P, Hussain M, Amrita, Kumar V. A rare extra‐pulmonary presentation of tuberculosis as gum tuberculosis. SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS. 2013;10(1):37-9.
Makaju R, Mohammad A, Thakur NK. Scenario of extrapulmonary tuberculosis in a tertiary care center. J Nepal Health Res Counc. 2010;8(1):48-50.
Fatmi TI, Jamal Q. A morphological study of chronic granulomatous lymphadenitis with the help of special stains. Pakistan Journal of Medical Sciences. 2002; 18(1): 48 -51.
Kamboj S, Goel MM, Tandon P, Natu SM, Nath P. Correlative study of histopathology and bacteriology in patients of tubercular lymphdenitis. The Indian Journal Chest Disease and Allied Science. 1994; 36(4):187-91.
Wiwatworapan T, Anantasetagoon T. Extra pulmonary tuberculosis at a regional hospital in Thailand. Southeast Asian J Trop Med Pub Health. 2008;39(3): 521-5.
Sreeramareddy CT, Panduru KV, Verma SC, Joshi HS, Bates MN. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study. BMC Infect Dis 2008; 8:8.
Ullah S, Shah SH, Aziz-ur-Rehman, Kamal A, Begum N, Khan G. Extrapulmonary tuberculosis in Lady Reading Hospital Peshawar, NWFP, Pakistan: survey of biopsy results. J Ayub Med Coll Abottabad. 2008; 20(2): 43-6.
Lowieke AM. Beek T, Marieke J, Werf V, Richter C, Borgdorff MW. Extrapulmonary Tuberculosis by Nationality, the Netherlands, 1993–2001. Emerging Infectious Diseases. 2006; 12(9):1375-82.
Chandir S, Hussain H, Amir M, Lotia I, Javed A Khan, Salahuddin N, Ali F. Extrapulmonary Tuberculosis: A retrospective review of 194 cases at a tertiary care hospital in Karachi, Pakistan, JPMA.2010;60 (2):105-9.
Solovic I, Jonsson J, Korzeniewska-Koseła M, Chiotan DI, Pace-Asciak A, Slump E, et al. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. Euro Surveill. 2013; 18(12) . pii: 20432.
Sandren A, Hollo V, van der Werf M J. Extrapulmonary tuberculosis in the European Union and Europian Economic Area, 2002 to 2011. Euro Surveill. 2013; 18(12): Accessed on 12-12-2014 from URL:http://www.eurosurveillance.org/images/dynamic/ee/v18n12/art20431.pdf
Prakasha SR, Suresh G, D’sa IP, Shetty SS, Kumar SG. Mapping the Pattern and Trends of Extrapulmonary Tuberculosis. J Glob Infect Dis. 2013;5(2): 54–59