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Epidemiology of extrapulmonary tuberculosis in central Guangxi from 2016 to 2021

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Abstract

The burden of extrapulmonary tuberculosis (EPTB) has gradually increased in recent years, but not enough epidemiological data is available from central Guangxi. To better understand the epidemiology of EPTB in central Guangxi and identify risk factors associated with them, we retrospectively investigated the epidemiology of tuberculosis (TB), especially EPTB, among patients admitted to the Chest Hospital of Guangxi Zhuang Autonomous Region between 2016 and 2021. We excluded those infected with both pulmonary tuberculosis (PTB) and EPTB, reported the proportion and incidence of PTB or EPTB, and compared the demographic characteristics and risk factors of EPTB and PTB cases using univariate and multivariate logistic regression models. Among 30,893 TB patients, 67.25% (20,774) had PTB and 32.75% (10,119) had EPTB. Among EPTB, pleural, skeletal, lymphatic, pericardial, meningeal, genitourinary, intestinal, and peritoneal TB accounted for 49.44%, 27.20%, 8.55%, 4.39%, 3.36%, 1.48%, 0.87%, and 0.79%, respectively. Patients who were younger (age < 25), from rural areas, Zhuang and other ethnic groups, and diagnosed with anemia and HIV infection were more likely to develop EPTB. However, patients with diabetes and COPD were less likely to have EPTB. From 2016 to 2021, the proportion of PTB cases decreased from 69.73 to 64.07%. The percentage of EPTB cases increased from 30.27 to 35.93%, with the largest increase in skeletal TB from 21.48 to 34.13%. The epidemiology and risk factors of EPTB in central Guangxi are different from those of PTB. The incidence of EPTB is increasing and further studies are needed to determine the reasons for it.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available because of ethical and legal reasons but are available from the corresponding author Jing Leng on reasonable request.

References

  1. WHO (2020) Tuberculosis. Available from: https://www.who.int/health-topics/tuberculosis#tab=tab_1.

  2. Yadav J et al (2019) Tuberculosis: current status, diagnosis, treatment and development of novel vaccines. Curr Pharm Biotechnol 20(6):446–458

    Article  CAS  Google Scholar 

  3. Solovic I et al (2013) Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin 18(12)

  4. Bomanji J et al (2020) PET/CT features of extrapulmonary tuberculosis at first clinical presentation: a cross-sectional observational F-FDG imaging study across six countries. Eur Respir J 55(2)

  5. Banta JE et al (2020) Pulmonary vs. extra-pulmonary tuberculosis hospitalizations in the US [1998-2014]. J Infect Public Health 13(1):131–139

    Article  Google Scholar 

  6. Thakur K et al (2018) The global neurological burden of tuberculosis. Semin Neurol 38(2):226–237

    Article  Google Scholar 

  7. Mazza-Stalder J, Nicod L, Janssens JP (2012) Extrapulmonary tuberculosis. Rev Mal Respir 29(4):566–578

    Article  CAS  Google Scholar 

  8. Sharma SK, Mohan A, Kohli M (2021) Extrapulmonary tuberculosis. Expert Rev Respir Med 15(7):931–948

    Article  CAS  Google Scholar 

  9. Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ (2019) Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics : a Review Publication of the Radiological Society of North America, Inc,. 39(7):2023–2037

  10. WHO (2021) Tuberculosis data. Available from: https://www.who.int/teams/global-tuberculosis-programme/data

  11. Qian X et al (2018) Risk factors for extrapulmonary dissemination of tuberculosis and associated mortality during treatment for extrapulmonary tuberculosis. Emerg Microbes Infect 7(1):102

    Article  Google Scholar 

  12. Khan AH et al (2019) Treatment outcomes and risk factors of extra-pulmonary tuberculosis in patients with co-morbidities. BMC Infect Dis 19(1):691

    Article  Google Scholar 

  13. Sotgiu G et al (2017) Determinants of site of tuberculosis disease: An analysis of European surveillance data from 2003 to 2014. PLoS One 12(11):e0186499

    Article  Google Scholar 

  14. Chakaya J et al (2021) Global Tuberculosis Report 2020 - Reflections on the Global TB burden, treatment and prevention efforts. Int J Infect Dis IJID Off Publ Int Soc For Infect Dis 113:Suppl 1

    Google Scholar 

  15. Cui Z et al (2017) Risk factors associated with Tuberculosis (TB) among people living with HIV/AIDS: A pair-matched case-control study in Guangxi, China. PLoS One 12(3):e0173976

    Article  Google Scholar 

  16. Zeng H et al (2021) Analysis of clinical characteristics of 556 spinal tuberculosis patients in two tertiary teaching hospitals in Guangxi Province. Biomed Res Int 2021:1344496

    Article  Google Scholar 

  17. Zheng Y et al (2020) Statistical methods for predicting tuberculosis incidence based on data from Guangxi, China. BMC Infect Dis 20(1):300

    Article  Google Scholar 

  18. Pang Y et al (2019) Epidemiology of extrapulmonary tuberculosis among inpatients, China, 2008–2017. Emerg Infect Dis 25(3):457–464

    Article  Google Scholar 

  19. Liu Y et al (2020) Description of demographic and clinical characteristics of extrapulmonary tuberculosis in Shandong. China Hippokratia 24(1):27–32

    CAS  Google Scholar 

  20. Chen L et al (2021) Upward trends in new, rifampicin-resistant and concurrent extrapulmonary tuberculosis cases in northern Guizhou Province of China. Sci Rep 11(1):18023

    Article  CAS  Google Scholar 

  21. WHO (2009) Treatment of tuberculosis guidelines. Available from: http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf

  22. Health MO (2004) Guidelines for diabetes control and prevention in China., Beijing: Peking University Press

  23. Ohene S-A et al (2019) Extra-pulmonary tuberculosis: A retrospective study of patients in Accra, Ghana. PLoS One 14(1):e0209650

    Article  CAS  Google Scholar 

  24. Wang X et al (2014) Insight to the epidemiology and risk factors of extrapulmonary tuberculosis in Tianjin, China during 2006–2011. PLoS One 9(12):e112213

    Article  Google Scholar 

  25. Norbis L et al (2014) Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis. Expert Rev Anti Infect Ther 12(5):633–647

    Article  CAS  Google Scholar 

  26. Minnies S et al (2021) Xpert MTB/RIF ultra is highly sensitive for the diagnosis of tuberculosis lymphadenitis in a High-HIV setting. J Clin Microbiol 59(12):e0131621

    Article  Google Scholar 

  27. Zhou Y et al (2021) Aptamer detection of mannose-capped lipoarabinomannan in lesion tissues for tuberculosis diagnosis. Front Cell Infect Microbiol 11:634915

    Article  CAS  Google Scholar 

  28. Khosravi AD et al (2017) Identification of in clinical specimens of patients suspected of having extrapulmonary tuberculosis by application of nested PCR on five different genes. Front Cell Infect Microbiol 7:3

    Article  Google Scholar 

  29. Singh BK et al (2020) Evaluation of genotype MTBDRplus V2 and genotype MTBDRsl V2 for the diagnosis of extrapulmonary tuberculosis in India. Tuberculosis (Edinb) 125:102014

    Article  CAS  Google Scholar 

  30. Mandal N et al (2017) Diagnosis and treatment of paediatric tuberculosis: An insight review. Crit Rev Microbiol 43(4):466–480

    Article  Google Scholar 

  31. Roy A et al (2014) Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis. BMJ (Clinical Research ed) 349:g4643

    CAS  Google Scholar 

  32. Pang Y et al (2016) Current status of new tuberculosis vaccine in children. Hum Vaccin Immunother 12(4):960–970

    Article  Google Scholar 

  33. Wang J et al (2021) Two cases of disseminated BCG disease following vaccination in the same family: case reports and review of the literature in China. Hum Vaccin Immunother 17(5):1382–1386

    Article  Google Scholar 

  34. Han J et al (2020) Mechanisms of BCG in the treatment of bladder cancer-current understanding and the prospect. Biomed Pharmacother = Biomed Pharmacother 129:110393

    Article  CAS  Google Scholar 

  35. Kang W et al (2020) The epidemiology of extrapulmonary tuberculosis in China: A large-scale multi-center observational study. PLoS One 15(8):e0237753

    Article  CAS  Google Scholar 

  36. Sreeramareddy CT et al (2008) Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study. BMC Infect Dis 8:8

    Article  Google Scholar 

  37. Al-Otaibi F, El Hazmi MM (2010) Extra-pulmonary tuberculosis in Saudi Arabia. Indian J Pathol Microbiol 53(2):227–231

    Article  Google Scholar 

  38. Guler SA et al (2015) Evaluation of pulmonary and extrapulmonary tuberculosis in immunocompetent adults: a retrospective case series analysis. Med Princ Pract Int J Kuwait Univ Health Sci Cent 24(1):75–79

    Google Scholar 

  39. Davis AG et al (2019) The pathogenesis of tuberculous meningitis. J Leukoc Biol 105(2):267–280

    Article  CAS  Google Scholar 

  40. Rajagopalan S (2016) Tuberculosis in Older Adults. Clin Geriatr Med 32(3):479–491

    Article  Google Scholar 

  41. Wu X-R et al (2012) Pediatric tuberculosis at Beijing Children’s Hospital: 2002–2010. Pediatrics 130(6):e1433–e1440

    Article  Google Scholar 

  42. Apidechkul T (2016) A 20-year retrospective cohort study of TB infection among the Hill-tribe HIV/AIDS populations, Thailand. BMC Infect Dis 16:72

    Article  Google Scholar 

  43. Zhou Y-B et al (2014) HIV-, HCV-, and co-infections and associated risk factors among drug users in southwestern China: a township-level ecological study incorporating spatial regression. PLoS One 9(3):e93157

    Article  Google Scholar 

  44. Pan D et al (2019) Infectivity of Genotypes and Outcome of Contact Investigation in Classroom in Guangxi, China. BioMed Res Int 2019:3980658

    Article  Google Scholar 

  45. Culqui-Lévano DR, Rodriguez-Valín E, Donado-Campos JdM (2017) Analysis of extrapulmonary tuberculosis in Spain: 2007-2012 National Study. Enferm Infecc Microbiol Clin 35(2):82–87

    Article  Google Scholar 

  46. Shivakoti R et al (2017) Association of HIV infection with extrapulmonary tuberculosis: a systematic review. Infection 45(1):11–21

    Article  Google Scholar 

  47. Piskur ZI, Mykolyshyn LI (2021) Comorbidities at the Tuberculosis among Children. Wiadomosci Lekarskie (Warsaw, Poland : 1960). 74(10 pt 1):2433–2438

  48. Schümann K, Solomons NW (2017) Perspective: What Makes It So Difficult to Mitigate Worldwide Anemia Prevalence? Advances In Nutrition (Bethesda, Md.) 8(3):401–408

  49. Chhabra S et al (2021) Anemia and Nutritional Status in Tuberculosis Patients. Int J Appl Basic Med Res 11(4):226–230

    Article  CAS  Google Scholar 

  50. Mukherjee A et al (2019) Prevalence, characteristics, and predictors of tuberculosis associated anemia. J Fam Med Prim Care 8(7):2445–2449

    Article  Google Scholar 

  51. Kerkhoff AD et al (2016) Anaemia in patients with HIV-associated TB: relative contributions of anaemia of chronic disease and iron deficiency. Int J Tuberc Lung Dis Off J Int Union Against Tuberc Lung Dis 20(2):193–201

    CAS  Google Scholar 

  52. Leeds IL et al (2012) Site of extrapulmonary tuberculosis is associated with HIV infection. Clin Infect Dis Off Publ Infect Dis Soc Am 55(1):75–81

    Article  Google Scholar 

  53. Gomes T et al (2014) Epidemiology of extrapulmonary tuberculosis in Brazil: a hierarchical model. BMC Infect Dis 14:9

    Article  Google Scholar 

  54. Le Y et al (2020) Infection of Promotes Both M1/M2 Polarization and MMP Production in Cigarette Smoke-Exposed Macrophages. Front Immunol 11:1902

    Article  CAS  Google Scholar 

  55. Jin J et al (2018) Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications. Int J Chron Obstruct Pulmon Dis 13:375–384

    Article  CAS  Google Scholar 

  56. Shirzad-Aski H et al (2020) Incidence, risk factors and clinical characteristics of extra-pulmonary tuberculosis patients: a ten-year study in the North of Iran. Trop Med Int Health TM IH 25(9):1131–1139

    Article  Google Scholar 

  57. Magee MJ et al (2016) Diabetes mellitus and extrapulmonary tuberculosis: site distribution and risk of mortality. Epidemiol Infect 144(10):2209–2216

    Article  CAS  Google Scholar 

  58. Lee MK et al (2021) Risk factors for the delayed diagnosis of extrapulmonary TB. Int J Tuberc Lung Dis Off J Int Union Against Tuberc Lung Dis 25(3):191–198

    CAS  Google Scholar 

  59. Khanna K, Sabharwal S (2019) Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine J Off J North Am Spine Soc 19(11):1858–1870

    Article  Google Scholar 

  60. Pigrau-Serrallach C, Rodríguez-Pardo D (2013) Bone and joint tuberculosis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cervic Spine Res Soc 22(Suppl 4):556–566

    Article  Google Scholar 

  61. Zhu B et al (2018) Tuberculosis vaccines: Opportunities and challenges. Respirology (Carlton, Vic.). 23(4):359–368

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Acknowledgements

We thank Peng Zhang for his help in data processing techniques. Thanks to all participants of this study and Guangxi Chest Hospital for their support.

Funding

This research was supported by Guangxi Key Research and Development Program (Nos. GuikeAB20072005 and GuikeAB22035027). Jing Leng and Yanling Hu were received research grants from these two funds, respectively.

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Author notes

  1. Lanxiang Li and Yu Lv contributed equally to this work.

Authors and Affiliations

  1. Department of Immunology, Basic Medical College of Guangxi Medical University, Nanning, 530021, Guangxi, China

    Lanxiang Li & Jing Leng

  2. Chest Hospital of Guangxi Zhuang Autonomous Region, No. 8 Yangjiaoshan Road, Liuzhou, 545005, Guangxi, China

    Yu Lv, Lingsong Su, Qianyu Liu, Ke Lan, Di Wei, Qingguo Wu, Jiannan Lv, Aimei Liu & Yongzhong Wei

  3. School of Information and Management, Guangxi Medical University, Nanning, 530021, Guangxi, China

    Yanling Hu, Bo Xie & Zengjing Liu

  4. Institute of Life Sciences, Guangxi Medical University, Nanning, 530021, Guangxi, China

    Yanling Hu & Xihua Wei

  5. Center of Genomic and Personalized Medicine, Guangxi Medical University, Nanning, 530021, Guangxi, China

    Yanling Hu

  6. Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, 530021, Guangxi, China

    Xianwu Pang

  7. Guangxi Key Laboratory of Translational Medicine for Treating High-Incidence Infectious Diseases With Integrative Medicine, Guangxi University of Chinese Medicine, Nanning, 530200, Guangxi, China

    Jing Leng

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  1. Lanxiang Li
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Contributions

All authors contributed to study conception and design. Y.L.H, J.L, J.N.L, Y.Z.W, A.M.L: designed the study and provided the correlative knowledge. D.W, L.S.S, Q.Y.L, and K.L: collected and provided the data. L.X.L, X.W.P, B.X, Z.J.L, and X.H.W extracted data and cleaned data. L.X.L, X.W.P, and B.X generated the figures and tables. L.X.L, J.L, Y.Z.W, Y.L.H, and J.N.L: wrote and edited the manuscript. All of the authors read and approved the final manuscript.

Corresponding authors

Correspondence to Aimei Liu, Jing Leng or Yongzhong Wei.

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Ethical considerations

This study was approved by the Ethics Committee of the Chest Hospital of Guangxi Zhuang Autonomous Region (approval number: 2022–09). The study used data collected from the patient records of the hospital inpatient information management system. To protect the privacy of patients, the hospital gave them a digital password and kept their names, ID numbers, and other details confidential. The hospital’s Institutional Review Board approved the waiver of patients’ informed consent because the study posed no risks for patients.

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Li, L., Lv, Y., Su, L. et al. Epidemiology of extrapulmonary tuberculosis in central Guangxi from 2016 to 2021. Eur J Clin Microbiol Infect Dis 42, 129–140 (2023). https://doi.org/10.1007/s10096-022-04524-2

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