Ekstrapulmoner tüberküloz olgularının epidemiyolojik profili: 4 yıllık deneyim

Year 2020, Volume: 45 Issue: 3, 1033 - 1041, 30.09.2020

Pınar Etiz Ali Tanju Altunsu

https://doi.org/10.17826/cumj.737325

Abstract

Amaç: Bu çalışmada Adana Verem Savaş Dispanserine kayıtlı ekstrapulmoner tüberküloz olgularının demografik özelliklerinin incelenmesi, organ ve doku yerleşimleri açısından dağılımı, tanıda kullanılan yöntemlerin belirlenmesi ve tedavi sonuçlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: 2014-2017 yılları arasında ekstrapulmoner tüberküloz tanısı ile tedavi ve takip edilen 400 olgu geriye dönük olarak incelendi ve analiz edildi. Olguların demografik özellikleri, ilaç duyarlılık testleri, takip ve tedavi sonuçları değerlendirildi. Akciğer dışı tüberküloz vakaları için veriler tüberküloz kayıtları, tedavi kartları ve kişisel tıbbi dosyalarından toplandı.
Bulgular: Çalışmaya alınan olguların yaşı 0-87 yıl arasında değişmekte olup (ortalama yaş: 41,19±19,97 yıl), 245 (%61,2)’i kadındır. En sık tutulan bölgenin lenf nodu (%38,8) olduğu, bunu %17,8’lik oranla plevra ve %9,0'luk oranla gastrointestinal tutulumun izlediği belirlenmiştir. Yapılan ilaç duyarlılık testi sonucunda, çok ilaca dirençli tüberküloza rastlanmamıştır. Tedavi tamamlama oranı %95,7'dir.
Sonuç: Bu çalışmanın sonuçları, Adana'da 4 yıllık dönemde akciğer dışı tüberküloz epidemiyolojisi hakkında bilgi vermektedir. Olguların en üretken yaşlarda görülmesi ülkemizin ekonomik kaybının boyutlarını göstermesi açısından önemlidir. Tüberküloz akciğer dışında en sık lenf düğümlerini tutmakla birlikte tüm organ ve dokuları tutabilen bir enfeksiyon hastalığı oldugu gösterilmiştir. Ülkemiz gibi tüberküloz açısından endemik olan ülkelerde, ekstrapulmoner tüberküloz olgularının epidemiyolojik ve klinik özelliklerinin daha geniş seriler ile araştırılmasının, hastalığın erken tanı ve tedavisi açısından önemli olduğu düşünülmüştür

Keywords

Epidemiyoloji, Ekstrapulmoner Tüberküloz, Tedavi Sonucu, Türkiye

Epidemiological profile of extrapulmonary tuberculosis cases: 4 year-experience

Abstract

Purpose: The aim of this study was to examine the demographic features, organ and tissue distribution, diagnostic methods and treatment outcomes of extrapulmonary tuberculosis cases who were registered to the Adana Tuberculosis Dispensary.
Materials and Methods: 400 cases, who were diagnosed with extrapulmonary tuberculosis, treated and followed up between 2014 and 2017, were examined and analyzed retrospectively. Their demographic characteristics, drug susceptibility tests, follow‑ups and treatment outcomes were reviewed. Individual data for extrapulmoary tuberculosis cases were collected from tuberculosis registers, tuberculosis medical personal files and treatment cards.
Results: In total, 400 cases of extrapulmoary tuberculosis were recorded. Patients were within the range of 0 to 87 years old (mean age: 41.19±19.97 years), and 245 of them (61.2%) were female. Tuberculosis most frequently affected lymph nodes (38.8%), followed by pleura (17.8%) and gastrointestinal tract (9.0%). None of the cases had multidrug-resistant tuberculosis. Treatment completion rates were high and reached 95.8%.
Conclusion: The present findings provide information about the epidemiology of extrapulmonary tuberculosis in Adana during the 4-year period. The occurrence of cases at the most productive age is important to show the degree of economic loss in Turkey. Tuberculosis is a contagious illness that mainly affects the lymph nodes rather than the lungs. Investigations into epidemiological and clinical characteristics of extrapulmonary tuberculosis in large number of cases might be crucial to early diagnosis and therapy in endemic countries such as Turkey.

Keywords

Epidemiology, Extrapulmonary tuberculosis, Treatment outcome, Turkey

References

• 1- Ben Ayed H, Koubaa M, Marrakchi C, Rekik K, Hammami F et al. Extrapulmonary Tuberculosis: Update on the Epidemiology, Risk Factors and Prevention Strategies. Int J Trop Dis. 2018;1-6. 2- World Health Organization. Global tuberculosis report 2018. WHO/CDS/TB/2018.20. Geneva: The Organization; 2018. https://apps.who.int/iris/handle/10665/274453 (date of access: 2020 April 10) 3- Guler SA, Bozkus F, Inci MF, Kokoglu OF, Ucmak H, Ozden S et al. Evaluation of Pulmonary and Extrapulmonary Tuberculosis in Immunocompetent Adults: A Retrospective Case Series Analysis. Med Princ Pract. 2015;24:75-79. 4- Yu Pang, Jun An, Wei Shu, Fengmin Huo, Naihui Chu, Mengqiu Gao et al. Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008–2017. Emerging Infectious Diseases 2019;25(3):457-64. 5- Ji Yeon Lee, M.D. Diagnosis and Treatment of Extrapulmonary Tuberculosis. Tuberc Respir Dis. 2015;78:47-55. 6- Güngör S, Soğukpınar Ö, Yalçınsoy M, Afşar Dönmez BB, Akkan O, Akkütük Öngel E et al. Rare Extrapulmonary Tuberculosis in Immunocompetent Adults: Experience of a Tertiary Hospital. Eur Arch Med Res. 2019;35(3):115-9. 7- Pala K, Gerçek H, Aydin Taş T, Çakir R, Özgüç S, Yildiz T. 30 years retrospective review of tuberculosis cases in a tuberculosis dispensary in Bursa/Nilufer, Turkey (1985-2014): Changes of epidemics. Mediterr J Hematol Infect Dis. 2016,8(1):e2016059 8- Sağlık Bakanlığı. Tüberküloz Tanı ve Tedavi Rehberi, Ankara, 2019. https://hsgm.saglik.gov.tr/depo/birimler/tuberkuloz_db/haberler/Tuberkuloz_Tani_Ve_Tedavi_Rehberi_/Tuberkuloz_Tani_ve_Tedavi_Rehberi.pdf (date of access: 2020 April 18) 9- Tatar D, Senol G, Alptekin S, Gunes E, Aydın M, Gunes O. Assessment of Extrapulmonary Tuberculosis in Two Provinces of Turkey. Iran J Public Health. 2016;45(3):305-13. 10- Gambhir S, Ravina M, Rangan K, Dixit M, Barai S, Bomanji J. International Atomic Energy Agency Extra-pulmonary TB Consortium. Imaging in extrapulmonary tuberculosis. Int J Infect Dis. 2017;56:237-47. 11- Gunal S, Yang Z, Agarwal M, Koroglu M, Kazgan Arıcı Z, Durmaz R. Demographic and microbial characteristics of extrapulmonary tuberculosis cases diagnosed in Malatya, Turkey, 2001-2007. BMC Public Health 2011;11:154. 12- Arciniegas W, Orjuela D. Extrapulmonary tuberculosis a review of 102 cases in Pereira, Colombia. Biomedica 2006;26:71-80. 13- Sreeramareddy C, Panduru K, Verma S, Joshi H, Bates M. Comprasion of pulmonary and extrapulmonary tuberculosis Nepal-a hospital based retrospective study. BMC Infect Dis. 2008;8(8):1-7. 14- Ilgazlı A, Boyacı H, Başyigit I, Yıldız F. Extrapulmonary tuberculosis: Clinical and epidemiological spectrum of 636 cases. Arch Med Res. 2004;35:435-41. 15- Velingker A, Lawande D, Dcosta L. Clinico-epidemiological profile of extrapulmonary tuberculosis in Western India. International Journal of Contemporary Medical Research 2018;5(2):B1-B4. 16- Desai U, Joshi JM. Extrapulmonary drug-resistant tuberculosis at a drug-resistant tuberculosis center, Mumbai: Our experience-Hope in the midst of despair! Lung India 2019;36:3-7. 17- Noertjojo K, Tam C, Chan S, Chan-Yeung M. Extrapulmonary and pulmonary tuberculosis in Hong Kong. Int J Tuberc Lung Dis. 2002;6:879-86. 18- M. Forssbohm, M Zwahle, R Loddenkemper, H.L. Rieder. Demographic characteristics of patients with extrapulmonary tuberculosis in Germany. Eur Respir J. 2008;31:99–105. 19- 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(2):199-205. 20- Fader T, Parks J, Khan NU, Manning R, Stokes S, Nasır NA. Extrapulmonary tuberculosis in Kabul, Afghanisthan: A hospital-based retrospective review. International Journal of Infectious Disease.2010;14,e102-e110. 21- Ohene S-A, Bakker MI, Ojo J, Toonstra A, Awudi D, Klatser P. Extra-pulmonary tuberculosis: A retrospective study of patients in Accra, Ghana. PLoS ONE 2019;14(1):e0209650. 22- 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):1-8. 23- Prakasha SR, Suresh G, D`sa IP, Shetty SS, Kumar SG. Mapping the pattern and trends of extrapulmonary tuberculosis. J Global Infect Dis. 2013;5:54-9. 24- Zenebe Y, Anagaw B, Tesfay W, Debebe T, Gelaw B. Smear positive extrapulmonary tuberculosis disease at Gondar Hospital, Northwest Ethopia.BMC Research Notes 2013;6:21. 25- Gaifer Z. Epidemiology of extrapulmonary and disseminated tuberculosis in a tertiary care center in Oman. Int J Mycobacteriol. 2017;6:162-6. 26- Gomes T, Vinhas SA, Reis-Santos B, Palaci M, Peres RL, Aguiar PP et al. Extrapulmonary Tuberculosis: Mycobacterium tuberculosis Strains and Host Risk Factors in a Large Urban Setting in Brazil. PLoS ONE 2013;8(10):e74517. 27- Sevgi DY, Derin O, Alpay AS, Gündüz A, Konuklar AS, Bayraktar B et al. Extrapulmonary tuberculosis: 7 year experience of a tertiary center in Istanbul. European Journal of Internal Medicine 2013;24:864-67. 28- Culqui-Lévanoa, DR Rodriguez-Valínc E, Donado-Campose JM. Analysis of extrapulmonary tuberculosis in Spain: 2007–2012 National Study. Enferm Infecc Microbiol Clin. 2017;35(2):82-87. 29- Holden IK, Lillebaek T, Andersen PH, Bjerrum S, Wejse C, Johansen IS. Extrapulmonary Tuberculosis in Denmark From 2009 to 2014; Characteristics and Predictors for Treatment Outcome. Open Forum Infect Dis. 2019;6(10):1-9. 30- T.C Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü,Türkiye'de Verem Savaşı 2018 Raporu. https://hsgm.saglik.gov.tr/depo/birimler/tuberkuloz_db/dosya/raporlar/Turkiye_de_Verem_Savas_2018_Raporu_kapakl_.pdf (date of access: 2020 April 18) 31- Al-HajojS, Shoukri M, Memish Z, Al Hakeem R, Al Rabiah F, Varghese B et al. Exploring the Sociodemographic and Clinical Features of Extrapulmonary Tuberculosis in Saudi Arabia. PLoS ONE 2015;10(2):e0101667. 32- Khan AH, Sulaiman SAS, Laghari M, Hassali MA, Muttalif AR, Bhatti Z et al. Treatment outcomes and risk factors of extra-pulmonary tuberculosis in patients with co-morbidities. BMC Infectious Diseases 2019;19:1-14.