Karim M R, Alam M A, Mamun S A A, Rahman M A
Bangladesh Med Res Counc Bull. 2015 Aug;41(2):59-66. doi: 10.3329/bmrcb.v41i2.29975.
Bangladesh ranks sixth among higher TB burden countries. Extra-pulmonary TB contributes 12% of all tuberculosis cases in 2008. Risk factors for EPTB in Bangladesh are hypothesized to be different from pulmonary tuberculosis as seen in other high-burden countries. A case control study was conducted to compare the sociodemographic, household condition and lifestyle characteristics between extra pulmonary and pulmonary tuberculosis. This case control study was conducted in thirteen sub districts of Pabna, Shirajgonj and Cox's Bazar districts from January to June 2013. The samples were classified as either extra pulmonary tuberculosis EPTB (cases) or pulmonary tuberculosis PTB (controls). A total of 490 participants including 245 extra pulmonary tuberculosis (cases) and 245 pulmonary tuberculosis (controls), who were being enrolled in DOTS treatment for last six months, were interviewed for epidemiological and clinical information using a standardized questionnaire. Children, adolescent and younger adults had four-time higher risk of being manifested with extra pulmonary tuberculosis [Adjusted odds ratio (AOR) 3.97; 95% Confidence Interval (CI) 1.10 to 14.35] and (AOR 4.50; 95% CI 1.48 to 13.72). Respondents, who lived in their own houses showed three times more chance of getting extra pulmonary disease (AOR 3.11; 95% CI 1.15 to 8.39). Extra pulmonary tuberculosis was seven to eight times more likely to occur among those whose resided in bedrooms ventilated with one (p= .001) or more windows (p =.004) and having window shutter made of glasses or wood slit raised the probability of getting extra pulmonary involvement by twenty times. Households using grain husk and leaves as cooking fuel revealed seven times higher chance of being manifested as extra pulmonary tuberculosis (P <.001). Extra pulmonary cases were three times more common among respondents, who had no history of exposure with known tuberculosis cases than those who had frequent exposure history (AOR 3.01; 95% CI 1.24 to 7.34). Extra pulmonary tuberculosis was found 1.5 times more common among BCG vaccinated respondents than pulmonary tuberculosis (AOR 1.66; 95% CI 1.06 to 2.58). Younger age, house ownership, bedroom ventilation, fuel material used for cooking, contact history and BCG vaccination status might be the important risk factors for the extra pulmonary manifestation of tuberculosis relative to pulmonary tuberculosis.
孟加拉国在结核病高负担国家中排名第六。2008年，肺外结核病占所有结核病病例的12%。据推测，孟加拉国肺外结核病的危险因素与其他高负担国家的肺结核不同。开展了一项病例对照研究，以比较肺外结核病和肺结核患者的社会人口统计学、家庭状况和生活方式特征。这项病例对照研究于2013年1月至6月在帕布纳、锡拉杰甘杰和科克斯巴扎尔地区的13个分区进行。样本分为肺外结核病（病例）或肺结核（对照）。共有490名参与者，包括245例肺外结核病患者（病例）和245例肺结核患者（对照），他们在过去六个月中接受了直接观察短程治疗，使用标准化问卷对其进行了流行病学和临床信息访谈。儿童、青少年和年轻人患肺外结核病的风险高出四倍[调整优势比（AOR）为3.97；95%置信区间（CI）为1.10至14.35]以及（AOR为4.50；95%CI为1.48至13.72）。居住在自有房屋中的受访者患肺外疾病的几率高出三倍（AOR为3.11；95%CI为1.15至8.39）。居住在有一扇（p = 0.001）或更多窗户通风的卧室中的人患肺外结核病的可能性高出七至八倍（p = 0.004），而有玻璃或木质百叶窗的窗户会使发生肺外感染的概率提高二十倍。使用谷壳和树叶作为烹饪燃料的家庭患肺外结核病的几率高出七倍（P < 0.001）。与有频繁接触已知结核病病例史的受访者相比，无已知结核病病例接触史的受访者患肺外病例的可能性高出三倍（AOR为3.01；95%CI为1.24至7.34）。接种卡介苗的受访者患肺外结核病的几率比患肺结核的几率高1.5倍（AOR为1.66；95%CI为1.06至2.58）。相对于肺结核而言，年龄较小、拥有房屋、卧室通风情况、烹饪所用燃料材料、接触史和卡介苗接种状况可能是结核病肺外表现的重要危险因素。
