Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun 6;7(1):102.
doi: 10.1038/s41426-018-0106-1.

Risk factors for extrapulmonary dissemination of tuberculosis and associated mortality during treatment for extrapulmonary tuberculosis

Xu Qian  1   2   3 , Duc T Nguyen  4 , Jianxin Lyu  1   3 , Andreas E Albers  5 , Xiaohong Bi  2 , Edward A Graviss  6
Affiliations

Risk factors for extrapulmonary dissemination of tuberculosis and associated mortality during treatment for extrapulmonary tuberculosis

Xu Qian et al. Emerg Microbes Infect. .

Abstract

Many environmental, host, and microbial characteristics have been recognized as risk factors for dissemination of extrapulmonary tuberculosis (EPTB). However, there are few population-based studies investigating the association between the primary sites of tuberculosis (TB) infection and mortality during TB treatment. De-identified population-based surveillance data of confirmed TB patients reported from 2009 to 2015 in Texas, USA, were analyzed. Regression analyses were used to determine the risk factors for EPTB, as well as its subsite distribution and mortality. We analyzed 7007 patients with exclusively pulmonary TB, 1259 patients with exclusively EPTB, and 894 EPTB patients with reported concomitant pulmonary involvement. Age ≥45 years, female gender, human immunodeficiency virus (HIV)-positive status, and end-stage renal disease (ESRD) were associated with EPTB. ESRD was associated with the most clinical presentations of EPTB other than meningeal and genitourinary TB. Patients age ≥45 years had a disproportionately high rate of bone TB, while foreign-born patients had increased pleural TB and HIV+ patients had increased meningeal TB. Age ≥45 years, HIV+ status, excessive alcohol use within the past 12 months, ESRD, and abnormal chest radiographs were independent risk factors for EPTB mortality during TB treatment. The epidemiologic risk factors identified by multivariate analyses provide new information that may be useful to health professionals in managing patients with EPTB.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Flowchart of the study population.
TBGIMS Genotyping Information Management System, PTB pulmonary TB, EPTB extrapulmonary TB
Fig. 2
Fig. 2. Distribution of extrapulmonary tuberculosis by site and associated mortality.
a Distribution of extrapulmonary sites in patients with concurrent pulmonary tuberculosis (PTB) or exclusively extrapulmonary tuberculosis (EPTB). b Mortality distribution by extrapulmonary sites in patients with exclusively EPTB
See this image and copyright information in PMC

References

    1. World Health Organization. Global Tuberculosis Report (2016). http://www.who.int/tb/publications/global_report/en/
    1. Pai M, et al. Tuberculosis. Nat. Rev. Dis. Primers. 2016;2:16076. doi: 10.1038/nrdp.2016.76. - DOI - PubMed
    1. Sandgren A, Hollo V, van der Werf MJ. Extrapulmonary tuberculosis in the European Union and European Economic Area, 2002 to 2011. Eur. Surveill. 2013;18:20431. - PubMed
    1. Sama JN, et al. High proportion of extrapulmonary tuberculosis in a low prevalence setting: a retrospective cohort study. Public Health. 2016;138:101–107. doi: 10.1016/j.puhe.2016.03.033. - DOI - PMC - PubMed
    1. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin. Infect. Dis. 2009;49:1350–1357. doi: 10.1086/605559. - DOI - PubMed

Substances

LinkOut - more resources