A study of extra-pulmonary tuberculosis and its outcome

Ravikumar P., Priyadarshini Bai G.


Background: Pulmonary tuberculosis being the predominant manifestation of the disease extra-pulmonary sites can also involve as a result of dissemination from a chief focus. Extra- pulmonary tuberculosis is more common in HIV cases. The present study aims to determine the presentation and outcome of patients with extra-pulmonary tuberculosis treated with DOTS and to assess any difference in outcome of treatment in HIV positive extra-pulmonary tuberculosis.

Methods: Data was collected from cases of tuberculosis patients diagnosed and treated under DOTS at Sri Siddhartha Medical College for the period of one year (during 2015). We evaluated extra-pulmonary cases and recorded sites of involvement in order of frequency. We also studied treatment outcome by recording as per definitions given by the WHO and also evaluated any difference in outcome of extra-pulmonary tuberculosis disease with HIV co-infection.

Results: Extra-pulmonary cases accounted for 30.5% of total TB cases. Among 224 cases of extra-pulmonary TB studied, 136 (60.7%) were males and 88 (39.3%) were females. Most common site of extra-pulmonary tuberculosis was pleura (29.9%) followed by meninges (22.5%), abdomen (19.6%) and lymph node (10.7%) tuberculosis. Among these patients 82.2% completed treatment, 7.5% were defaulted, 9.9% died and 0.4% treatment failure. The most common reason for default was irregular treatment (29.5%) followed by alcohol abuse (23.5%). Among 8 HIV reactive patients, 5 patients completed treatment and the remaining 3 patients died during the course of treatment.

Conclusions: Extra-pulmonary Tuberculosis accounts for 30.5% of the total cases studied. Pleura is most common site of extra-pulmonary TB in our study. Treatment irregularities and alcohol abuse are the two most common reasons for default.   Co-infection with HIV seems to have a poor outcome on patients with extra-pulmonary TB and needs to be studied in large number of samples.


DOTS, Extra-pulmonary tuberculosis, HIV co-infection, TB, WHO

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Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician. 2005; 72(9):1761-8.

Sharma SK, Mohan A, Sharma A, Mitra DK. Miliary tuberculosis: new insights into an old disease. Lancet Infect Dis. 2005;5(7):415-30.

Global tuberculosis report 2015. Available at 9789241565059_eng.pdf. Accessed on 4 July 2016.

Chandir S, Hussain H, Amir M, Lotia I, Khan AJ, Salahuddin N, Ali F. Extra pulmonary tuberculosis: a retrospective review of 194 cases at a tertiary care hospital in Karachi, Pakistan. J Pak Med Asso. 2010;60(2):1-6.

Gupta KB, Kumar A, Sen R, Sen J, Verma M. Role of ultrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis. Indian J Tuberc. 2007;54:71-8.

Sandgren A, Cuevas LE, Dara M, Gie RP, Grzemska M, Hawkridge A, et al. Childhood tuberculosis: progress requires an advocacy strategy now. Eur Respir J. 2012;40(2):294-7.

Sandgren A, Hollo V, Quinten C, Manissero D. Childhood tuberculosis in the European Union/European Economic Area, 2000 to 2009. Euro Surveill. 2011;16(12):19825.

European centre for disease prevention and control. Available at http:// /en /publications /Publications/0803_SPR_TB_Action_plan.pdf. Accessed on 12 July 2016.

World Health Organisation (WHO). The global plan to stop TB 2011-2015. Geneva. WHO;2010.

Davies PD, Barnes P, Gordon SB. Clinical Tuberculosis. 4th Edition. London: Hodder Arnold; 2008.

Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH. Thoracic sequelae and complications of tuberculosis. Radiographics. 2001;21(4):839-60.

Lenk S, Schroeder J. Genitourinary tuberculosis. Curr Opin Urol. 2001;11(1):93-8.

Malaviya AN, Kotwal PP. Arthritis associated with tuberculosis. Best Pract Res Clin Rheumatol. 2003;17(2):319-43.

Okanurak K, Kitayapor D, Wanarangsikul W, Koompong C. Effectiveness of DOT for tuberculosis treatment outcome: a prospective study in Bangkok, Thailand. Int J Tuberc Lung disease. 2007;11(7):762-8.

Diel R, Niemann S. Outcome of tuberculosis treatment in Hamburg: a survey 1997-2001. Int J Tuberc Lung Dis. 2003;7(2):124-31.

Khan MA, Basit A, Javaid ZA. Outcome of tuberculosis patients registered during 2007 in major teaching hospitals of Peshawar. JPMI. 2009;23(04):358-62.

Chennaveerappa PK, Siddharam SM, Halesha BR, Vittal BG, Jayashree N. Treatment outcome of tuberculosis patients registered at dots centre in a teaching hospital, south India. Int J Biol Med Res. 2011;2(2):487-9.

Chandrashekaran V, Gopi PG, Subramani R, Thomas A, Jaggarajamma K, Narayanan PR. Default during the intensive phase of treatment under DOTS programme. Indian J Tuberc. 2005;52:197-02.

Tekle B, Mariam DH, Ali A. Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia. Int J Tuberc Lung Dis. 2002;6(7):573-9.