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. 2022 Sep 10;75(4):604-612.
doi: 10.1093/cid/ciab1018.

Incidence and Mortality of Extrapulmonary Tuberculosis in Ukraine: Analysis of National Surveillance Data

Sara Khalife  1 , Helen E Jenkins  2 , Mariia Dolynska  3 , Iana Terleieva  4 , Iurii Varchenko  4 , Tao Liu  5 , E Jane Carter  6 , C Robert Horsburgh  2   7   8 , Natasha R Rybak  6 , Vasyl Petrenko  3 , Silvia S Chiang  1   9
Affiliations

Incidence and Mortality of Extrapulmonary Tuberculosis in Ukraine: Analysis of National Surveillance Data

Sara Khalife et al. Clin Infect Dis. .

Abstract

Background: Improved understanding of the epidemiology and mortality risk factors of extrapulmonary tuberculosis (EPTB) may facilitate successful diagnosis and management.

Methods: We analyzed national surveillance data from Ukraine to characterize EPTB subtypes (ie, localized in different anatomic sites). We calculated annual reported incidence, stratified by age, sex, and human immunodeficiency virus (HIV) status. Using Cox regression, we estimated mortality risk factors.

Results: Between January 2015 and November 2018, 14 062 adults/adolescents (≥15 years) and 417 children (<15 years) had EPTB with or without concomitant pulmonary TB. The most commonly reported EPTB subtypes were pleural, peripheral lymph node, and osteoarticular. Most EPTB subtype notifications peaked at age 30-39 years and were higher in males. In adults/adolescents, most peripheral TB lymphadenitis, central nervous system (CNS) TB, and abdominal TB occurred in those with untreated HIV. CNS TB notifications in people without HIV peaked before age 5 years. Adults/adolescents with CNS TB (adjusted hazard ratio [aHR]: 3.22; 95% CI: 2.89-3.60) and abdominal TB (aHR: 1.83; 95% CI: 1.59-2.11) were more likely to die than those with pulmonary TB. Children with CNS TB were more likely to die (aHR: 88.25; 95% CI: 43.49-179.10) than those with non-CNS TB. Among adults/adolescents, older age and HIV were associated with death. Rifampicin resistance was associated with mortality in pleural, peripheral lymph node, and CNS TB.

Conclusions: We identified the most common EPTB subtypes by age and sex, patterns of EPTB disease by HIV status, and mortality risk factors. These findings can inform diagnosis and care for people with EPTB.

Keywords: adolescents; children; epidemiology; public health surveillance; tuberculous meningitis.

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Conflict of interest statement

Potential conflicts of interest. E. J. C. serves on the Technical Review Committee of Unitaid and the Training Division of the International Union Against Tuberculosis and Lung Disease (IUATLD). C. R. H. serves on the data safety monitoring board, the safety advisory board, and the steering committee of BEAT-Tuberculosis, TB PRACTECAL, and STREAM, respectively. He also serves as Vice President of the North American Region of the IUATLD. M. D. reports providing expert support in development of the national tuberculosis (TB) care standard. V. P. reports being a member of the TB Expert Board of Ministry of Health of Ukraine. I. T. reports being a lead of NTP or Ukraine and is responsible for TB-related data analysis and presenting. I. V. reports being a member of Ukrainian NTP team and being responsible for TB-related data analysis and presenting. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Average annual incidence of extrapulmonary tuberculosis, Ukraine: 2015–2017. Abbreviation: HIV, human immunodeficiency virus.
See this image and copyright information in PMC

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