Desai Unnati, Joshi Jyotsna M
Department of Pulmonary Medicine, T. N. Medical College, B. Y. L. Nair Hospital, Mumbai, Maharashtra, India.
Lung India. 2019 Jan-Feb;36(1):3-7. doi: 10.4103/lungindia.lungindia_192_18.
Drug-resistant tuberculosis (DR-TB) is a global problem with only 52% reported cure rate. Extrapulmonary (EP) DR-TB poses a formidable diagnostic, therapeutic challenge. We aimed to study their clinical profile and treatment outcomes under the programmatic setting.
This retrospective observational study included the database of consecutive EPDR-TB cases enrolled at the DR-TB center from 2012 to 2014. The demographic, clinical details, drug susceptibility tests (DSTs), follow-up, therapy, adverse events (AEs), and outcome were reviewed. Statistical analysis was done using percentages and mean.
Of total 1743 DR-TB patients, 76 (4.4%) EPDR-TB cases were included. These consisted of 53 (69.7%) adults and 23 (30.3%) children, with female preponderance. The mean age in adults and children was 27.96 (9.63) and 12.56 (3.83), respectively. EP sites involved were lymph nodes in 39 (51.3%), spine in 15 (19.7%), other bones in 6 (7.9%), pleural effusion in 9 (11.9%), central nervous system in 2 (2.6%), and disseminated EP disease in 5 (6.6%). Forty-one (53.9%) had multi-DR-TB (MDR-TB), 29 (38.2%) MDR-TB with fluoroquinolone resistance {preextensively DR-TB (Pre-XDR-TB (FQ)), 1 (1.3%) MDR-TB with aminoglycoside resistance (Pre-XDR-TB (AM)), and 5 (6.6%) extensively DR-TB (XDR-TB) on DST. Thirteen (17.11%) had comorbidities. None had HIV. Two (2.63%) had DM. Patients were treated as per the revised TB control program - programmatic management of DR-TB guidelines. Duration of intensive (IP) was 6.55 (1.22) months. Ten (13.2%) received shorter regimens, wherein therapy was stopped at 12-18 months due to severe adverse drug reactions and treatment response. Sixty-two (81.6%) completed treatment, 8 (10.5%) defaulted, 3 (4%) died, 2 (2.6%) failed, and 1 (1.3%) was transferred out. Two-third of patients reported AE.
The prevalence of EP cases in DR-TB was 4.4%. Treatment completion rate was very high (81.6%). Shorter regimens were efficacious.
耐多药结核病（DR-TB）是一个全球性问题，报告的治愈率仅为52%。肺外（EP）耐多药结核病带来了巨大的诊断和治疗挑战。我们旨在研究在规划环境下它们的临床特征和治疗结果。
这项回顾性观察性研究纳入了2012年至2014年在耐多药结核病中心登记的连续性肺外耐多药结核病病例数据库。回顾了人口统计学、临床细节、药物敏感性试验（DST）、随访、治疗、不良事件（AE）和结果。使用百分比和均值进行统计分析。
在总共1743例耐多药结核病患者中，纳入了76例（4.4%）肺外耐多药结核病病例。其中包括53例（69.7%）成人和23例（30.3%）儿童，女性占多数。成人和儿童的平均年龄分别为27.96（9.63）岁和12.56（3.83）岁。涉及的肺外部位有39例（51.3%）为淋巴结，15例（19.7%）为脊柱，6例（7.9%）为其他骨骼，9例（11.9%）为胸腔积液，2例（2.6%）为中枢神经系统，5例（6.6%）为播散性肺外疾病。41例（53.9%）患有多重耐药结核病（MDR-TB），29例（38.2%）为对氟喹诺酮耐药的MDR-TB{广泛耐药前结核病（Pre-XDR-TB（FQ）），1例（1.3%）为对氨基糖苷类耐药的MDR-TB（Pre-XDR-TB（AM）），5例（6.6%）根据DST为广泛耐药结核病（XDR-TB）。13例（17.11%）有合并症。无人感染艾滋病毒。2例（2.63%）患有糖尿病。患者按照修订后的结核病控制规划——耐多药结核病规划管理指南进行治疗。强化期（IP）持续时间为6.55（1.22）个月。10例（13.2%）接受了较短疗程，其中由于严重药物不良反应和治疗反应，治疗在12至18个月时停止。62例（81.6%）完成治疗，8例（10.5%）失访，3例（4%）死亡，2例（2.6%）治疗失败，1例（1.3%）转出。三分之二的患者报告有不良事件。
耐多药结核病中肺外病例的患病率为4.4%。治疗完成率非常高（81.6%）。较短疗程有效。
