Bir Devlet Hastanesindeki Ekstrapulmoner Tüberküloz Hastalarının Değerlendirilmesi

Year 2025, Volume: 15 Issue: 1, 1 - 6, 03.01.2025

Murat Aydın , Nurten Nur Aydın , Sibel İba Yılmaz

https://doi.org/10.33631/sabd.1454402

Abstract

Amaç: Tüberküloz, başta akciğerler olmak üzere vücudun tüm organlarını etkileyebilen bir hastalıktır ve dünya genelinde önemli bir halk sağlığı sorunu olmaya devam etmektedir. Ekstrapulmoner tüberküloz (EPTB) ise, akciğer dışındaki organlarda ve sistemlerde görülen ve çeşitli klinik bulgularla seyreden bir tüberküloz formudur. Bu çalışmanın amacı, EPTB olgularının dağılımının, klinik bulgularının ve tanı yöntemlerinin değerlendirilmesidir.
Gereç ve Yöntemler: Ocak 2017 ile Temmuz 2023 tarihleri arasında EPTB tanısı konan hastaların verileri retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, komorbiditeleri, tüberkülozun organ ve/veya sistem tutulumu ile hastalığa bağlı sekel ve mortalite oranları incelendi.
Bulgular: Çalışmada EPTB konan 56 hastanın 35’i (%62,5) kadın, 21’i (%37,5) erkek olup yaş ortalaması 46,4±18,6 idi. En sık görülen komorbidite diyabetes mellitus idi. En sık görülen EPTB formu lenfadenit (%35,7, n=20) ve ikinci en yaygın tutulum bölgesi plevra (n= 8, %14,3) idi. En nadir görülen EPTB formu kemik eklem tulumuydu (bir hasta, %1,8). Tutulum gösteren lenf nodlarının dağılımına bakıldığında, servikal (%50), aksiller (%35), mediastinel (%5), ve supraklavikular (%5) şeklindeydi. Hastaların 19’unda (%33,9) mikrobiyolojik bulgular (Asidorezistan boyama ve/veya tüberküloz kültürü ve/veya M. tuberculosis polimeraz zincir reaksiyonu) pozitif bulunurken, histopatolojik bulgular (patolojik kazeifikasyonlu/patolojik kazeifikasyonsuz nekrotizan granülom) 33 (%58,9) hastada tanıyı destekleyici nitelikteydi. Genel mortalite oranı %10,7 idi.
Sonuç: EPTB, gelişmekte olan ülkelerde mortaliteye sebep olabilen önemli bir sağlık sorunudur. Klinik şüphe durumunda mikrobiyolojik, histopatolojik, radyolojik ve klinik bulgular ile tanısal değerlendirme yapılmalı ve tüberküloz karşıtı tedaviye hemen başlanmalıdır.

Keywords

M. tuberculosis, lenfadenit, ekstrapulmoner tüberküloz

Evaluation of Extrapulmonary Tuberculosis Patients in a State Hospital

Abstract

Aim: Tuberculosis is a disease that can affect any organ of the body, particularly the lungs, and remains a major public health problem worldwide. Extrapulmonary tuberculosis (EPTB) is a form of tuberculosis that occurs in organs and systems other than the lungs and is characterized by various clinical findings. The aim of this study was to evaluate the distribution, clinical findings and diagnostic methods of EPTB cases.
Material and Methods: Data from patients diagnosed with EPTB between January 2017 and July 2023 were retrospectively evaluated. Demographic characteristics, comorbidities, organ and/or systemic involvement of tuberculosis, disease-related outcomes, and mortality rates were analyzed.
Results: Of the 56 patients diagnosed with EPTB, 35 (62.5%) were female and 21 (37.5%) were male with a mean age of 46.4 ± 18.6 years. The most common comorbidity was diabetes mellitus. The most common form of EPTB was lymphadenitis (35.7%, n=20) and the second most common site of involvement was the pleura (n=8, 14.3%). The rarest form of EPTB was bone joint tulum (one patient, 1.8%). The distribution of affected lymph nodes was cervical (50%), axillary (35%), mediastinal (5%), and supraclavicular (5%). Microbiological findings (Asido resistance stain and/or tuberculosis culture and/or M. tuberculosis polymerase chain reaction) were positive in19 patients (33.9%), while histopathological findings (necrotizing granuloma with/without pathological caseation) supported the diagnosis in 33 patients. The overall mortality rate was 10.7%.
Conclusion: EPTB is an important health problem that can cause mortality in developing countries. If clinically suspected, a diagnostic assessment based on microbiological, histopathological, radiological and clinical findings should be carried out and anti-tuberculosis treatment should be started immediately.

Keywords

M. tuberculosis, lymphadenitis, Extrapulmonary tuberculosis

References

• Gambhir S, Ravina M, Rangan K, Dixit M, Barai S, Bomanji J. Imaging in extrapulmonary tuberculosis. International Journal of Infectious Diseases. 2017; 56: 237-47.
• Heye T, Stoijkovic M, Kauczor HU, Junghanss T, Hosch W. Extrapulmonary tuberculosis: radiological imaging of an almost forgotten transformation artist. Rofo. 2011; 183(11): 1019-29.
• Tanyel E, Deveci A, Şensoy L, Temoçin F, Öztomurcuk D. Erişkin ekstrapulmoner tüberküloz olgularının irdelenmesi. Klimik Derg. 2023; 36(1): 52-7.
• Mathiasen VD, Hansen AK, Eiset AH, Lillebaek T, Wejse C. Delays in the diagnosis and treatment of tuberculous lymphadenitis in low-ıncidence countries: A systematic review. Respiration. 2019; 97(6): 576-84.
• Fanosie A, Gelaw B, Tessema B, Tesfay W, Admasu A, Yitayew G. Mycobacterium tuberculosis Complex and HIV co-ınfection among extrapulmonary tuberculosis suspected cases at the University of Gondar Hospital, Northwestern Ethiopia. PLoS One. 2016; 11(3): e0150646.
• Tarakçı A, Eroğlu E, Çölkesen F, Kacar F, Armağan ŞÖ, Selver C. The evaluation of the cases with extrapulmonary tuberculosis. Journal of Health Sciences and Medicine. 2021; 4(4): 451-6.
• Raza A, Rahman H, Nahar M. Socio-demographic patterns of tuberculosis patients, experience of a tertiary care medical college hospital of Bangladesh. J Lung Pulm Respir Res. 2016; 3(6): 00104.
• Smaoui S, Mezghanni MA, Hammami B, Zalila N, Marouane C, Kammoun S, et al. Tuberculosis lymphadenitis in a southeastern region in Tunisia: Epidemiology, clinical features, diagnosis and treatment. Int J Mycobacteriol. 2015; 4(3): 196-201.
• Fazal Iw, Habib Ur R, Ahmad I. Extrapulmonary tuberculosis in patients with cervical lymphadenopathy. J Pak Med Assoc. 2013; 63(9): 1094-7.
• Baykan AH, Sayiner HS, Aydin E, Koc M, Inan I, Erturk SM. Extrapulmonary tuberculosıs: an old but resurgent problem. Insights Imaging. 2022; 13(1): 39.
• Kim PM, Lee JJ, Choi D, Eoh H, Hong YK. Endothelial lineage-specific interaction of Mycobacterium tuberculosis with the blood and lymphatic systems. Tuberculosis (Edinb). 2018; 111: 1-7.
• Aslan G, Ülger M, Delialioğlu N, Otağ ZF, Apa DD, Ersöz G, et al. Mersin ilindeki akciğer dışı tüberküloz olgularının mikrobiyolojik ve demografik olarak değerlendirilmesi. Türk Mikrobiyol Cem Derg. 2017; 47(4): 197-204.
• Chakrabarti B, Davies P. Pleural tuberculosis. Monaldi archives for chest disease. 2006; 65(1).
• Seddon JA, Tugume L, Solomons R, Prasad K, Bahr NC, Consortium TMIR. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome open research. 2019; 4: 167.
• Leonard MK, Blumberg HM. Musculoskeletal tuberculosis. Microbiol Spectr. 2017; 5(2). https://doi.org/10.1128/microbiolspec.TNMI7-0046-2017.
• Hitit ÖG, Göktaş P, Erdem İ, Özyürek SÇ, Yüksel S. Erişkinde 67 akciğerdışı tüberküloz olgusunun değerlendirilmesi. İnfeksiyon Derg. 2005; 19(4): 407-13.
• Ligthelm LJ, Nicol MP, Hoek KG, Jacobson R, van Helden PD, Marais BJ, et al. Xpert MTB/RIF for rapid diagnosis of tuberculous lymphadenitis from fine-needle-aspiration biopsy specimens. J Clin Microbiol. 2011; 49(11): 3967-70.
• Yıldız PA, Karamanlıoğlu D, Özger HS, Katı H, Tunçcan ÖG, Dizbay M. Extrapulmonary tuberculosis: clinical and diagnostic features and risk factors for early mortality. Acta Medica. 2022; 53(4): 367-74.
• Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, et al. Executive summary: official american thoracic society/centers for disease control and prevention/ınfectious diseases society of america clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016; 63(7): 853-67.
• Ashby M, Grant H. Tuberculous meningitis treated with cortisone. Lancet. 1955; 268(6854): 65-6.
• Malhotra HS, Garg RK, Singh MK, Agarwal A, Verma R. Corticosteroids (dexamethasone versus intravenous methylprednisolone) in patients with tuberculous meningitis. Ann Trop Med Parasitol. 2009; 103(7): 625-34.
• Critchley JA, Young F, Orton L, Garner P. Corticosteroids for prevention of mortality in people with tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. 2013; 13(3): 223-37.
• Seiscento M, Vargas FS, Rujula MJP, Bombarda S, Uip DE, Galesi VMN. Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005). Jornal Brasileiro de Pneumologia. 2009; 35: 548-54.
• Doğanay M. Aygen B. Tüberküloz menenjit tedavisi. İnfeksiyon Bülteni. 1996; 1: 17-20.