Prakasha S Rama, Suresh G, D'sa Ivor Peter, Shetty Shobha S, Kumar S Ganesh
Department of Medicine, KSHEMA, Mangalore, Karnataka, India.
J Glob Infect Dis. 2013 Apr;5(2):54-9. doi: 10.4103/0974-777X.112277.
There has been a rapid expansion of the directly observed treatment short-term (DOTS) under the revised national tuberculosis control program throughout India in the last decade. Few reports exist detailing individual DOTS centers' experiences with regard to extrapulmonary tuberculosis (EPTB) in a medical college hospital setting.
This is a retrospective, record-based study of patients with the diagnosis of EPTB, in all age groups. Data on all consecutive EPTB cases diagnosed at the K. S. Hegde Medical College and Hospital, Deralakatte, Mangalore from 1 January 2005 to 31 December 2011 at the DOTS centre attached to this hospital were collected, analyzed by Mantel-Haenszel Chi square for linear trend and described in proportion or percentages.
Among 1267 cases registered for treatment of all forms of tuberculosis, 528 (41.67%) had EPTB. Around half of the cases of EPTB (269, 51%) were among adult age groups and the majority of cases (342, 64.77%) received Category-I treatment. Pleural TB was the commonest type of EPTB (n = 148, 28.03%), followed by lymph node TB (n = 131, 24.81%). Involvement of lymph nodes was the commonest manifestation among the less than 14 years' age group (27, 58.7%), while involvement of pleura was more common among > 65 years' age group (23, 45.1%). The difference in the occurrence of EPTB by site between males and females is statistically significant with a P value of <0.005. There is a significant increase in the number of cases of tuberculosis affecting bones and joints, and other forms of tuberculosis over the years.
The burden of EPTB is more among the productive age group. Increase in the trend of bone and joint tuberculosis, and other rare forms of EPTB is a point of concern highlighting the importance of strengthening the services towards this group.
在过去十年中，印度全国结核病控制规划修订版下的直接观察治疗短程化疗（DOTS）迅速扩展。很少有报告详细介绍医学院附属医院环境中各个DOTS中心在肺外结核病（EPTB）方面的经验。
这是一项基于记录的回顾性研究，研究对象为所有年龄组中诊断为EPTB的患者。收集了2005年1月1日至2011年12月31日在芒格洛尔市德拉拉卡特的K.S.赫格德医学院和医院的DOTS中心诊断的所有连续性EPTB病例的数据，采用Mantel-Haenszel卡方检验进行线性趋势分析，并以比例或百分比进行描述。
在登记接受各种形式结核病治疗的1267例病例中，528例（41.67%）患有EPTB。约一半的EPTB病例（269例，51%）属于成年年龄组，大多数病例（342例，64.77%）接受I类治疗。胸膜结核是最常见的EPTB类型（n = 148，28.03%），其次是淋巴结结核（n = 131，24.81%）。淋巴结受累是14岁以下年龄组中最常见的表现（27例，58.7%），而胸膜受累在65岁以上年龄组中更为常见（23例，45.1%）。男性和女性EPTB发病部位的差异具有统计学意义，P值<0.005。多年来，影响骨骼和关节的结核病病例数以及其他形式的结核病病例数有显著增加。
EPTB在生产年龄组中的负担较重。骨骼和关节结核病以及其他罕见形式的EPTB的上升趋势令人担忧，凸显了加强针对该群体服务的重要性。
