Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany.
Euro Surveill. 2013 Mar 21;18(12):20436.
Tuberculosis (TB) surveillance commonly focuses on pulmonary (PTB) where the main organ affected is the lung. This might lead to underestimate extrapulmonary TB (EPTB) forms, where in addition to the lung other sites are affected by TB. In Germany, TB notification data provide the main site and the secondary site of disease. To gain an overview of all the different EPTB forms, we analysed German TB notification data between 2002 and 2009 using information on both main and secondary disease site to describe all individual EPTB forms. Further, we assessed factors associated with meningitis using multivariable logistic regression. Solely analysing the main site of disease, lead to one third of EPTB manifestations being overlooked. Case characteristics varied substantially across individual extrapulmonary forms. Of 46,349 TB patients, 422 (0.9%) had meningitis as main or secondary site. Of those, 105 (25%) of the 415 with available information had died. Multivariable analysis showed that meningitis was more likely in children younger than five years and between five and nine years-old (odds ratio (OR): 4.90; 95% confidence interval (CI): 3.40–7.07 and OR: 2.65; 95% CI: 1.40–5.00), in females (OR: 1.42; 95% CI: 1.17–1.73), and in those born in the World Health Organization (WHO) regions of south-east Asia (OR: 2.38; 95% CI: 1.66–3.43) and eastern Mediterranean (OR: 1.51; 95% CI: 1.02–2.23). Overall, EPTB manifestations, including meningitis, which is often fatal, were underestimated by routine analysis. We thus recommend using all information on disease manifestation generated by surveillance to monitor severe forms and to transfer the gained knowledge to TB case management where awareness of EPTB is most important.
结核病（TB）监测通常集中在肺部（PTB），主要受影响的器官是肺部。这可能导致对肺外结核病（EPTB）形式的低估，除了肺部，其他部位也受到结核病的影响。在德国，结核病报告数据提供了主要部位和次要部位的疾病。为了全面了解所有不同的 EPTB 形式，我们使用主要和次要疾病部位的信息分析了 2002 年至 2009 年德国的结核病报告数据，以描述所有单独的 EPTB 形式。此外，我们使用多变量逻辑回归评估了与脑膜炎相关的因素。仅分析主要部位的疾病，导致三分之一的 EPTB 表现被忽视。病例特征在各个肺外形式之间差异很大。在 46349 例结核病患者中，422 例（0.9%）有脑膜炎作为主要或次要部位。其中，在有可用信息的 415 例中，有 105 例（25%）死亡。多变量分析显示，脑膜炎更可能发生在五岁以下和五到九岁之间的儿童（比值比（OR）：4.90；95%置信区间（CI）：3.40-7.07 和 OR：2.65；95% CI：1.40-5.00），在女性中（OR：1.42；95% CI：1.17-1.73），以及在世卫组织（WHO）东南亚（OR：2.38；95% CI：1.66-3.43）和东地中海（OR：1.51；95% CI：1.02-2.23）地区出生的人群中。总体而言，常规分析低估了包括脑膜炎在内的 EPTB 表现，而脑膜炎通常是致命的。因此，我们建议使用监测产生的所有疾病表现信息来监测严重形式，并将所获得的知识转移到结核病病例管理中，在结核病病例管理中，对 EPTB 的认识最重要。
