DOI: http://dx.doi.org/10.18203/2349-2902.isj20205889

Extrapulmonary tuberculosis: Are we barking up the wrong tree? A 4 year naturalistic follow up study

Ravi Ganji, Bushra Khan, Mohammad Jalaluddin, Haneefa Khan, Swaroop Ganji

Abstract


Background: Aim of the study was to determine if extra-pulmonary tuberculosis (EPTB) is a communicable disease as commonly perceived or a disease of host immune dysfunction.

Methods: Patients with clinical suspicion of EPTB, in general surgery and orthopaedic department of twin hospitals of Deccan College of Medical Sciences, between the period of January 2015 and December 2017, were investigated appropriately and those found to have confirmed TB were enrolled in the study and followed up for 1 year.

Simultaneously patient’s details registered under RNTCP in the two local community health centres were collected and compared with the hospital based study.

Results: Of 319 patients with clinical features, 267 were confirmed with EPTB- maximum number with lymph nodal disease (127) followed by extremity bone and joint (63), spine (38), skin and soft tissues (25) and abdominal tb (19). Method of confirmation differed for each site. Detection by AFB being the least sensitive followed by AFB culture. The best method of diagnosis being histopathological examination.

Conclusions: Immunity plays a major role in site of reactivation of TB and healing of disease irrespective of duration of anti-tuberculous chemotherapy or surgical intervention.


Keywords


Diagnostic criteria, Macrophage,Extraperitoneal, Surgical intervention, Tuberculosis immune response

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References


Wyngaarden JB, Smith LH, Bennett JC. Cecil Textbook of Medicine, 19th edition, W.B. Saunders Company. 1992:1733-1742.

Boyd WC. A Textbook of Pathology. Lippincott Williams and Wilkins. 8th edition. 1970:336-342.

Lin CY, Chen TC, Lu PL, Lai CC, Yang YH. Effects of gender and age on development of concurrent extrapulmonary tuberculosis in patients with pulmonary tuberculosis: a population based study. PLOS One. 2013;8(5):e63936.

Ganapathy S, Thomas BE, Jawahar MS. Perceptions of gender and tuberculosis in a south Indian urban community. Indian J Tuberc. 2008;55:9-14.

Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, et al. Identification of risk factors for extrapulmonary tuberculosis. Clinical Infect Dis. 2004;38:199-205.

Donald PR, Marais BJ, Barry LE. Age and the Epidemmology and pathogenesis of tuberculosis. Lancet. 2010;375:2110-19.

Sreeramareddy CT, Panduru KV, Verma SC, Joshi HS, Rates MN. Comparison of pulmonary and EPTB in Nepal- a hospital based retrospective study. BMC infect Dis. 2008;8:8.

Gopal R, Padmavathy BK, Vasanthi S, Jayashree K. EPTB a retropective study. Indian J Tuberculosis. 2001;48(4):225-6.

Adada H, Valley MA, Nour SA, Mehta J, Byrd RP, Anderson JL, et al. Epidemology of extrapulmonary in United states: high Rates persists in the post HIV era. Int J Tuberc Lung Dis. 2014;18(12):1516-21.

Wang X, Yang Z, Fu Y. Insight to the epidemology and risk factors of extrapulmonary tuberculosis in Tianjin, China during 2006-2011. PLOS One. 2014;9(12):e112213.

Purohit M, Mustafa T. Laboratory diagnosis of extrapulmonary tuberculosis in resource constrained setting: state of the art, challenges and the need. J Clin Diag Res. 2015;9(4):01-6.

Silverberg SG. Principles and practice of surgical pathology and cytopathology, 3rd edition, Cambridge University Press. 2003:170-171.

Sotgiu G, Falzon D, Hollo V. Determinants of site of tuberculosis diseases: an analysis of European Surveillance data from 2003 to 2014. PLOS One. 2017;12(11):e0186499.

Caws M, Thwaites G, Dunstan S. The influence of host and bacterial genotype on the development of disseminated disease with mycobacterium tuberculosis. PLOS Pathogens. 2008;4(3):e1000034.

Kauffmann SH, Cole ST, Mizrahi V. Mycobacterium tuberculosis and the host response. J Experim Med. 2005;201(11):1693-7.

Borgdorff MW, Nagelkerke NJ, Dye C, Nunn P. Gender and Tuberculosis a comparision of prevalence surveys with notification data to explore sex differences in case direction. Int J Tuberc Lung Dis. 2000;4(2):123-32.

Lin JN, Lai CH, Lee SJ. Risk factors for extrapulmonary tuberculosis compared to pulmonary tuberculosis. Int J Tuber Lung Dis. 2009;13(5):620-5.

Musellim B, Erturan S, Duman S. Comparison of extrapulmonary and pulmonary tuberculosis cases: factors influencing the site of reactivation. Int J Tuberc Lung Dis. 2005;9(11):1220-3.

Neyrolles O, Murci Q. Sexual inequality in tuberculosis. PLoS Medicine. 2009;6(12):1-6.

Padberg J, Feigenbaum JB, Sagebiel D. Association of Extrapulmonary tuberculosis with age, sex, and season differs depending on the affected organ. Int J Tuberc Lung Dis. 2015;19(6):723-8.

Wingfield T, Schumacher SG, Sandhu G. The seasonality of tuberculosis, sunlight, vitamin d and household crowding. J Infect Dis. 2014;210:774-83.

Sunnetcioglu A, Sunnetcioglu M, Binici I, Baran AI. Comparative analysis of pulmonary and extrapulmonary tuberculosis of 411 cases. Ann Clin Microbiol Antimicrob. 2015;14:34.

Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systemic review and meta analysis. Int J Epidemol. 2008;37:113-9.

Liv PT, Stenger S, Li H, Wengel L, Tan BH. Toll like receptors triggering of a vit D mediated human antimicrobial response. Science. 2001;11:1770-3.

White JH. Vitamin D signalling, infectious diseases and regulation of innate immunity. Infection Immunity. 2008;76:3837-43.

Bozza VV, D’Attilio L, Mahuad CV. Altered Cortisol/DHEA ratio in tuberculosis patients and its relationship with abnornalities in the mycobacterial driven cytokine production by peripheral blood mononuclear cells. Scandinavian J Immunol. 2007;66:97-103.

World Health Organisation. Treatment of Tuberculosis: Guidelines for National Programmes. WHO. Available at https://apps.who.int/i ris/bitstream/handle/10665/67890/WHO_CDS_TB_2003.313_eng.pdf;jsessionid=A0292667799FCA71EFC96F5856E1D6EC?sequence=1. Accessed on 12 July 2020.

Arora VK, Gupta R. Trends of extrapulmonary tuberculosis under revised national tuberculosis control programme: a study from south Delhi. Indian J Tuberc. 2006;53:77-83.

Pahari S, Negi S, Aqdas M. Induction of autophagy through CLEC4E in combination with TLR4: an innovative strategy to restrict the survival of Mycobacterium tuberculosis. Autophagy. 2019;5:98-105.

Mann CV, Russel RC. The healing and management of wounds. Bailey and Love’s Short Practice of Surgery. 21st edition. 1991:1.