Extra-pulmonary manifestations in a large metropolitan area with a low incidence of tuberculosis

Int J Tuberc Lung Dis. 2003 Dec;7(12):1178-85.

Abstract

Background: The increases in extra-pulmonary tuberculosis (EPTB) have been largely due to human immunodeficiency virus co-infection. The rates of EPTB have remained constant despite the decline in pulmonary tuberculosis (PTB) cases.

Objective: To evaluate covariates associated with EPTB.

Methods: A 4-year cohort of EPTB patients was compared with PTB cases. Enrollees were assessed for TB risk, medical records were reviewed, and Mycobacterium tuberculosis isolates were fingerprinted.

Results: We identified 538 EPTB cases (28.6%) in a total of 1878 enrollees. The most common sites of infection were lymph nodes (43%) and pleura (23%). EPTB cases included 320 (59%) males, 382 (71%) patients were culture-positive, and 332 (86.9%) patient isolates were fingerprinted. Fewer EPTB than PTB patients belonged to clustered M. tuberculosis strains (58% vs. 65%; P = 0.02). A multivariate model identified an increased risk for EPTB among African Americans (OR = 1.9, P = 0.01), HIV-seropositive (OR = 3.1, P < 0.01), liver cirrhosis (OR = 2.3, P = 0.02), and age <18 years (OR = 2.0, P = 0.04). Patients with concomitant pulmonary and extra-pulmonary infections were more likely to die within 6 months of TB diagnosis (OR = 2.3, P < 0.01).

Conclusions: African American ethnicity is an independent risk factor for EPTB. Mortality at 6 months is partly due to the dissemination of M. tuberculosis and the severity of the underlying co-morbidity.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis
  • AIDS-Related Opportunistic Infections / epidemiology*
  • Adult
  • Age Distribution
  • Aged
  • Ethnic Groups / statistics & numerical data*
  • Female
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / isolation & purification*
  • Odds Ratio
  • Probability
  • Risk Assessment
  • Rural Population
  • Sex Distribution
  • Survival Rate
  • Tuberculosis / diagnosis*
  • Tuberculosis / epidemiology*
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / epidemiology
  • United States / epidemiology
  • Urban Population