Open AccessThe epidemiology of extrapulmonary tuberculosis in China: A large-scale multi-center observational study
Author(s) -
Wanli Kang,
Jiajia Yu,
Juan Du,
Song I Yang,
Hongyan Chen,
Jianxiong Liu,
Jun Ma,
Mingwu Li,
Jianjie Qin,
Wei Shu,
Peilan Zong,
Yi Zhang,
Yongkang Dong,
Zhiyi Yang,
Zaoxian Mei,
Qunyi Deng,
Pu Wang,
Wenge Han,
Wu M,
Ling Chen,
Xinguo Zhao,
Lei Tan,
Fujian Li,
Chao Zheng,
Hongwei Liu,
Xinjie Li,
A Ertai,
Yingrong Du,
Fenglin Liu,
Cui Wenyu,
Quanhong Wang,
Xiaohong Chen,
Junfeng Han,
Qingyao Xie,
Yanghe Feng,
Wenyu Liu,
Peijun Tang,
Jianyong Zhang,
Jian Zheng,
Fan Chen,
Xiangyang Yao,
Tong Ren,
Li Yan,
Yuanyuan Li,
Lei Wu,
Qiang Song,
Mei Yang,
Jian Zhang,
Yuanyuan Liu,
Shuliang Guo,
Kun Yan,
Xinghua Shen,
Dan Lei,
Yanli Zhang,
Xiaofeng Yan,
Liang Li,
Shenjie Tang
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0237753
Subject(s) - medicine , tuberculosis , epidemiology , observational study , logistic regression , confounding , quartile , confidence interval , pathology
Tuberculosis (TB) remains a serious global public health problem in the present. TB also affects other sites (extrapulmonary tuberculosis, EPTB), and accounts for a significant proportion of tuberculosis cases worldwide. In order to comprehensively understand epidemiology of EBTB in China, and improve early diagnosis and treatment, we conducted a large-scale multi-center observational study to assess the demographic data and the prevalence of common EPTB inpatients, and further evaluate the prevalence of EPTB concurrent with Pulmonary tuberculosis (PTB) and the associations between multiple EPTB types and gender-age group in China. All consecutive age≥15yr inpatients with a confirmed diagnosis of EPTB during the period from January 2011 to December 2017 were included in the study. The descriptive statistical analysis included median and quartile measurements for continuous variables, and frequencies and proportions with 95% confidence intervals (CIs) for categorical variables. Multinomial logistic regression analysis was used to compare the association of multiple EPTB types between age group and gender. The results showed that the proportion of 15–24 years and 25–34 years in EPTB inpatients were the most and the ratio of male: female was 1.51. Approximately 70% of EPTB inpatients were concurrent with PTB or other types of EPTB. The most common of EPTB was tuberculous pleurisy (50.15%), followed by bronchial tuberculosis (14.96%), tuberculous lymphadenitis of the neck (7.24%), tuberculous meningitis (7.23%), etc. It was found that many EPTB inpatients concurrent with PTB. The highest prevalence of EPTB concurrent with PTB was pharyngeal/laryngeal tuberculosis (91.31%), followed by bronchial tuberculosis (89.52%), tuberculosis of hilar lymph nodes (79.52%), tuberculosis of mediastinal lymph nodes (79.13%), intestinal tuberculosis (72.04%), tuberculous pleurisy (65.31%) and tuberculous meningitis (62.64%), etc. The results from EPTB concurrent with PTB suggested that females EPTB inpatients were less likely to be at higher risk of concurrent PTB (aOR = 0.819, 95%CI:0.803–0.835) after adjusted by age. As age increasing, the trend risk of concurrent PTB decreased (aOR = 0.994, 95%CI: 0.989–0.999) after adjusted by gender. Our study demonstrated that the common EPTB were tuberculous pleurisy, bronchial tuberculosis, tuberculous lymphadenitis of the neck, tuberculous meningitis, etc. A majority of patients with pharyngeal/laryngeal tuberculosis, bronchial tuberculosis, tuberculosis of hilar/mediastinal lymph nodes, intestinal tuberculosis, tuberculous pleurisy, tuberculous meningitis, etc. were concurrent with PTB. Female EPTB inpatients were less likely to be at higher risk of concurrent PTB, and as age increasing, the trend risk of concurrent PTB decreased. The clinicians should be alert to the presence of concurrent tuberculosis in EPTB, and all suspected cases of EPTB should be assessed for concomitant PTB to determine whether the case is infectious and to help for early diagnosis and treatment.