Ekstrapulmoner Tüberkülozda Organ Tutulum Paternleri ve Mortalite: On İki Yıllık Retrospektif Bir Çalışma

Abstract

Amaç: Ekstrapulmoner tüberküloz (EPTB), küresel tüberküloz yükünün artan bir kısmını oluşturmaktadır ve Türkiye dâhil birçok ülkede insidansı yükselmektedir. Bu çalışmada, üçüncü basamak bir sağlık kuruluşunda EPTB tanısı alan erişkin hastaların demografik, klinik, tanısal ve tedaviye ilişkin özelliklerinin değerlendirilmesi amaçlanmıştır. Yöntem: Bu retrospektif kohort çalışmaya, Haziran 2010 – Mart 2022 tarihleri arasında Ankara’daki iki üçüncü basamak hastanede EPTB tanısı alan 18 yaş ve üzeri erişkin hastalar dâhil edilmiştir. Tanımlayıcı ve karşılaştırmalı istatistiksel analizler yapılmıştır. Bulgular: Toplam 93 hasta dâhil edilmiştir (%51,6 erkek; medyan yaş: 55 yıl). En sık tutulan bölgeler omurga/eklemler (%32,3), lenf nodları (%26,9) ve merkezi sinir sistemi (%16,1) idi. Histopatolojik doğrulama %60,2, kültür pozitifliği %30,1, PCR pozitifliği %31,2 oranında sağlandı. AFB boyası %25,8 pozitifti. İlaç duyarlılık testi %27,9 hastada yapılmış ve iki olguda direnç saptanmıştır. Hastaların %95,7’sine standart dörtlü anti-TB tedavisi uygulanmış, medyan tedavi süresi 6 ay (1–13 ay) idi. %22,6 hastada cerrahi müdahale gerekmiştir. Takipte 9 hasta (%9,7) hayatını kaybetti. Bağışıklık baskılanması ölenlerde anlamlı düzeyde daha fazlaydı (%44,4 vs. %11,9, p = 0,027) ve bu hastalarda tedavi süresi daha kısaydı (p < 0,001). Sonuç: EPTB erişkinlerde ciddi tablolarla seyredebilir. Vertebra ve merkezi sinir sistemi tutulumu sık olup, tanıda histopatoloji belirleyicidir. Bağışıklık baskılanması ve yetersiz tedavi süresi mortaliteyle ilişkilidir. Erken tanı ve bireyselleştirilmiş tedavi yaklaşımları önem taşımaktadır.

Keywords

• Ekstrapulmoner tüberküloz
• TB menenjiti
• mortalite
• histopatoloji
• spinal TB

Patterns of Organ Involvement and Mortality in Extrapulmonary Tuberculosis: A Twelve-Year Retrospective Study

Abstract

Objective: Extrapulmonary tuberculosis (EPTB) accounts for a growing proportion of the global TB burden, with rising incidence in many countries, including Türkiye. This study aimed to describe the demographic, clinical, diagnostic, and therapeutic characteristics of adult patients diagnosed with EPTB in a tertiary care setting. Methods: This retrospective cohort included adults (≥18 years) diagnosed with EPTB between June 2010 and March 2022 at two tertiary hospitals in Ankara. Descriptive and comparative statistical analyses were performed. Results: A total of 93 patients were included (51.6% male; median age: 55 years). The most affected sites were spine/joints (32.3%), lymph nodes (26.9%), and the central nervous system (16.1%). Histopathological confirmation was achieved in 60.2%, culture positivity in 30.1%, and PCR positivity in 31.2%. AFB staining was positive in 25.8%, and drug susceptibility testing was performed in 27.9%, revealing resistance in two patients. Standard four-drug anti-TB therapy was initiated in 95.7% of cases, with a median duration of 6 months (range: 1–13). Surgery was required in 22.6% of patients. Nine patients (9.7%) died during follow-up. Immunosuppression was significantly more common among non-survivors (44.4% vs. 11.9%, p = 0.027), who also had shorter durations of therapy (p < 0.001). Conclusion: EPTB in adults can present with severe forms, particularly spinal and CNS involvement. Histopathology remains a key diagnostic tool. Mortality was associated with immunosuppression and insufficient treatment duration, highlighting the need for early diagnosis and individualized management strategies.

Keywords

• Extrapulmonary tuberculosis
• spinal TB
• TB meningitis
• mortality
• histopathology

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