2014, Number 2
<< Back Next >>
salud publica mex 2014; 56 (2)
Clinical and epidemiological features of extrapulmonary tuberculosis in a high incidence region
Pérez-Guzmán C, Vargas MH, Arellano-Macías MR, Hernández-Cobos S, García-Ituarte AZ, Serna-Vela FJ
Language: English
References: 36
Page: 189-196
PDF size: 225.10 Kb.
ABSTRACT
Objective. To describe the clinical features of extrapulmonary tuberculosis (EXPTB) and to evaluate epidemiological data to search for potential explanations for its high frequency in the state of Aguascalientes, Mexico.
Materials and methods. Clinical records of all patients with tuberculosis seen in Aguascalientes in 2008 were reviewed, and official databases were analyzed.
Results. EXPTB comprised 60.5% of the 86 cases evaluated, being lymph nodes the main site affected. Patients with EXPTB were younger and more obese than subjects with pulmonary tuberculosis (PTB). One third of cases in either group had diabetes, a frequency much higher than expected. Epidemiological analysis showed that PTB incidence, but not EXPTB incidence, decreases as geographical altitude increases, and had a descendent trend from 1997 to 2011.
Conclusions. The lower frequency of PTB (due to its inverse relationship with altitude and its descendent trend in last years) might explain the high frequency of EXPTB. Obesity appeared to protect against developing pulmonary involvement, and diabetes was more frequent than expected among PTB and EXPTB cases.
REFERENCES
Centro Nacional de Vigilancia Epidemiológica y Control de Enfermedades. Anuarios de morbilidad. Mexico: Centro Nacional de Vigilancia Epidemiológica y Control de Enfermedades, 1984-2011.
World Health Organization. Global tuberculosis control: WHO report 2011. Geneva, Switzerland: WHO, 2011.
Kruijshaar ME, Abubakar I. Increase in extrapulmonary tuberculosis in England and Wales 1999-2006. Thorax 2009;64:1090-1095.
Te Beek LA, van der Werf MJ, Richter C, Borgdorff MW. [Increase in extrapulmonary tuberculosis in The Netherlands associated with an increase in the number of residents with non-Dutch nationality; observational study of data from 1993-2001]. Ned Tijdschr Geneeskd 2008;152:637-642.
Dankner WM, Davis CE. Mycobacterium bovis as a significant cause of tuberculosis in children residing along the United States-Mexico border in the Baja California region. Pediatrics 2000;105:E79.
Lari N, Rindi L, Cristofani R, Rastogi N, Tortoli E, Garzelli C. Association of Mycobacterium tuberculosis complex isolates of BOVIS and Central Asian (CAS) genotypic lineages with extrapulmonary disease. Clin Microbiol Infect 2009;15:538-543.
World Health Organization. Treatment of tuberculosis: guidelines. 4th ed. Geneve: WHO, 2010.
Instituto Nacional de Estadística y Geografía. Censo de Población y Vivienda 2010: Principales resultados por localidad (ITER). México: INEGI, 2010.
Anonymous. Baja prevalencia de tuberculosis bovina. InfoRural; 2009.
Instituto Nacional de Salud Pública. Encuesta Nacional de Salud y Nutrición 2006. Resultados por entidad federativa, Aguascalientes. Cuernavaca, México. INSP, 2007.
Vargas MH, Furuya ME, Pérez-Guzmán C. Effect of altitude on the frequency of pulmonary tuberculosis. Int J Tuberc Lung Dis 2004;8:1321-1324.
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.
Solovic I, Jonsson J, Korzeniewska-Kosela M, Chiotan DI, Pace-Asciak A, Slump E, et al. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. Euro Surveill 2013;18(12):pii=20432.
Sandgren A, Hollo V, van der Werf MJ. Extrapulmonary tuberculosis in the European Union and European Economic Area, 2002 to 2011. Euro Surveill 2013;18(12). pii: 20431.
De la Cruz J, Avelar FJ, Márquez F, Guerrero-Barrera AL. Panorama epidemiológico de la tuberculosis en Aguascalientes. Investigación y Ciencia 2008;40:38-41.
Rodríguez-Nuñez J, Avelar FJ, Márquez F, Rivas-Santiago B, Quiñones C, Guerrero-Barrera AL. Mycobacterium tuberculosis complex detected by modified fluorescent in situ hybridization in lymph nodes of clinical samples. J Infect Dev Ctries 2012;6:58-66.
Alvarado-Esquivel C, García-Corral N, Carrero-Domínguez D, Enciso-Moreno JA, Gurrola-Morales T, Portillo-Gómez L, et al. Molecular analysis of Mycobacterium isolates from extrapulmonary specimens obtained from patients in Mexico. BMC Clin Pathol 2009;9:1.
Garcia-Rodriguez JF, Alvarez-Diaz H, Lorenzo-Garcia MV, Marino-Callejo A, Fernandez-Rial A, Sesma-Sanchez P. Extrapulmonary tuberculosis: epidemiology and risk factors. Enferm Infecc Microbiol Clin 2011;29:502-509.
Kourbatova EV, Leonard MK, Jr., Romero J, Kraft C, del Rio C, Blumberg HM. Risk factors for mortality among patients with extrapulmonary tuberculosis at an academic inner-city hospital in the US. Eur J Epidemiol 2006;21:715-721.
Nissapatorn V, Kuppusamy I, Rohela M, Anuar AK, Fong MY. Extrapulmonary tuberculosis in Peninsular Malaysia: retrospective study of 195 cases. Southeast Asian J Trop Med Public Health 2004;35 Suppl 2:39-45.
Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, et al. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis 2004;38:199-205.
Sreeramareddy CT, Panduru KV, Verma SC, Joshi HS, Bates MN. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study. BMC Infect Dis 2008;8:8.
Forssbohm M, Zwahlen M, Loddenkemper R, Rieder HL. Demographic characteristics of patients with extrapulmonary tuberculosis in Germany. Eur Respir J 2008;31:99-105.
Jick SS, Lieberman ES, Rahman MU, Choi HK. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum 2006;55:19-26.
Bates MN, Khalakdina A, Pai M, Chang L, Lessa F, Smith KR. Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis. Arch Intern Med 2007;167:335-342.
Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med 2007;4:e20.
Slama K, Chiang CY, Enarson DA, Hassmiller K, Fanning A, Gupta P, et al. Tobacco and tuberculosis: a qualitative systematic review and meta-analysis. Int J Tuberc Lung Dis 2007;11:1049-1061.
Cagatay AA, Caliskan Y, Aksoz S, Gulec L, Kucukoglu S, Cagatay Y, et al. Extrapulmonary tuberculosis in immunocompetent adults. Scand J Infect Dis 2004;36:799-806.
Ebdrup L, Storgaard M, Jensen-Fangel S, Obel N. Ten years of extrapulmonary tuberculosis in a Danish university clinic. Scand J Infect Dis 2003;35:244-246.
Levine H, Szanto PB, Cugell DW. Tuberculous pleurisy. An acute illness. Arch Intern Med 1968;122:329-332.
Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung G, et al. Lower risk of tuberculosis in obesity. Arch Intern Med 2007;167:1297-1304.
Deniz O, Gumus S, Yaman H, Ciftci F, Ors F, Cakir E, et al. Serum total cholesterol, HDL-C and LDL-C concentrations significantly correlate with the radiological extent of disease and the degree of smear positivity in patients with pulmonary tuberculosis. Clin Biochem 2007;40:162-166.
Pérez-Guzmán C, Vargas MH, Quiñonez F, Bazavilvazo N, Aguilar A. A cholesterol-rich diet accelerates bacteriologic sterilization in pulmonary tuberculosis. Chest 2005;127:643-651.
Aghamohammadzadeh R, Heagerty AM. Obesity-related hypertension: Epidemiology, pathophysiology, treatments, and the contribution of perivascular adipose tissue. Ann Med 2012;44 Suppl 1:S74-S84.
Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis 2009;9:737-746.
Kapur A, Harries AD. The double burden of diabetes and tuberculosis - Public health implications. Diabetes Res Clin Pract 2013;pii: S0168-8227(12)00497-4.