Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia.
PLoS One. 2019 Mar 27;14(3):e0213846. doi: 10.1371/journal.pone.0213846. eCollection 2019.
Despite low infectious potential of extrapulmonary tuberculosis (EPTB), it poses significant clinical challenges in terms of diagnosis and treatment monitoring. Understanding the main demographical risk factors for disease characteristics of EPTB plays a crucial role in speeding up diagnosis process and improving overall clinical experience. The aim of this study was to investigate the main demographical and clinical risk factors for EPTB among adults and adolescents for the first time in Saudi Arabia. A cross-sectional multicenter study was carried out on a collection of 902 extrapulmonary Mycobacterium tuberculosis complex (MTBC) isolates with demographical and clinical data. All isolates were subjected to spoligotyping and 24-loci based MIRU-VNTR typing. The association between two potential variables was assessed using odd ratios (OR) calculations. Independent risk factors for EPTB and diseases characteristics of EPTB were identified using multivariate regression model analyses. Gender was found to be significantly associated with lymph node, gastrointestinal, central nervous system and urogenital TB. Lymph node TB showed statistical association to age group below 25 years, non-Saudis and South East Asian ethnicity. While gastrointestinal TB demonstrated an association with patients above 60 years old, and Saudis. Multivariate analysis showed that gender is an independent risk factor to urogenital TB (p 0.03) and lymph node TB (p 0.005). On the other hands, South Asian (p 0.01) and South East Asian (p 0.03) ethnicities were both identified as independent risk factors significantly associated with EPTB. MTBC lineages, site of infections, gender, HIV and smear positivity showed no significant association. Nationwide qualitative-studies are highly warranted in the future to further understand the main demographic risk factors for disease characteristics of EPTB.
尽管肺外结核病（EPTB）的传染性较低，但在诊断和治疗监测方面仍存在重大临床挑战。了解 EPTB 疾病特征的主要人口统计学危险因素对于加快诊断过程和改善整体临床经验至关重要。本研究旨在首次在沙特阿拉伯调查成人和青少年 EPTB 的主要人口统计学和临床危险因素。对 902 例肺外分枝杆菌复合群（MTBC）分离株进行了横断面多中心研究，收集了人口统计学和临床数据。所有分离株均进行 spoligotyping 和 24 位基于 MIRU-VNTR 的分型。使用比值比（OR）计算评估两个潜在变量之间的关联。使用多变量回归模型分析确定 EPTB 的独立危险因素和 EPTB 的疾病特征。结果发现，性别与淋巴结、胃肠道、中枢神经系统和泌尿生殖系统结核病显著相关。淋巴结结核病与 25 岁以下、非沙特人和东南亚种族的患者存在统计学关联。而胃肠道结核病与 60 岁以上的患者和沙特人有关。多变量分析显示，性别是泌尿生殖系统结核病（p 0.03）和淋巴结结核病（p 0.005）的独立危险因素。另一方面，南亚（p 0.01）和东南亚（p 0.03）种族均被确定为与 EPTB 显著相关的独立危险因素。MTBC 谱系、感染部位、性别、HIV 和涂片阳性与 EPTB 无显著相关性。未来需要进行全国范围的定性研究，以进一步了解 EPTB 疾病特征的主要人口统计学危险因素。
