Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.
Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia.
BMC Infect Dis. 2019 Aug 5;19(1):691. doi: 10.1186/s12879-019-4312-9.
Extra-pulmonary tuberculosis (EPTB) represents about 14% of all cases of tuberculosis (TB) in Malaysia. The aims of the study include evaluation of socio-demographic factors, clinical manifestations, co-morbidities among patients with EPTB and their treatment outcomes.
A retrospective study was conducted to recognize the epidemiology facts of EPTB. Individual data for EPTB patients were collected from TB registers, laboratory TB registers, treatment cards and TB medical personal files into a standardized study questionnaire. Crude (COR) and adjusted odds ratios (AOR) and 95% confidence intervals (CI) were determined to assess the risk factors for EPTB and unsuccessful treatment outcomes.
There were 1222 EPTB patients presenting 13.1% of all TB cases during 2006-2008. Pleural effusion and lymph node TB were the most frequent types and accounted for 45.1% of all EPTB cases among study participants. Treatment success rate was 67.6%. The best treatment completion rates were found in children ≤15 years (0.478 [0.231-1.028]; p = 0.05). On multivariate analysis, age group 56-65 years (1.658 [1.157-2.376]; p = 0.006), relapse cases (7.078 [1.585-31.613]; p = 0.010), EPTB-DM (1.773 [1.165-2.698]; p = 0.008), patients with no formal (2.266 [1.254-4.095]; p = 0.001) and secondary level of education (1.889 [1.085-3.288]; p = 0.025) were recorded as statistically positive significant risk factors for unsuccessful treatment outcomes. Patients at the risk of EPTB were more likely to be females (1.524 [1.311-1.746]; p < 0.001), Malays (1.251 [1.056-1.482]; p = 0.010) and Indians (1.450 [1.142-1.842]; p = 0.002), TB-HIV (3.215 [2.347-4.405]; p < 0.001), EPDM-HIV (4.361 [1.657-11.474]; p = 0.003), EPTB-HIV-HEP (4.083 [2.785-5.987]; p < 0.001), those living in urban areas (1.272 [1.109-1.459]; p = 0.001) and no formal education (1.361 [1.018-1.820]; p = 0.037).
The findings of this study extend the knowledge of EPTB epidemiology and highlight the need for improved EPTB detection in Malaysia, especially in subpopulations with high risk for EPTB and unsuccessful treatment outcomes.
在马来西亚，肺外结核（EPTB）约占所有结核病（TB）病例的 14%。本研究的目的包括评估 EPTB 患者的社会人口学因素、临床表现、合并症及其治疗结果。
本研究采用回顾性研究方法，对 EPTB 的流行病学特征进行了研究。从结核登记处、实验室结核登记处、治疗卡和结核医务人员档案中收集了 EPTB 患者的个体数据，并将其纳入标准化研究问卷。采用粗比（COR）和调整比值比（AOR）和 95%置信区间（CI）来评估 EPTB 和治疗结果不佳的危险因素。
2006-2008 年期间，1222 例 EPTB 患者占所有结核病病例的 13.1%。胸腔积液和淋巴结结核是最常见的类型，占研究参与者中所有 EPTB 病例的 45.1%。治疗成功率为 67.6%。在儿童（≤15 岁）中发现了最佳的治疗完成率（0.478 [0.231-1.028]；p=0.05）。多变量分析显示，年龄组 56-65 岁（1.658 [1.157-2.376]；p=0.006）、复发病例（7.078 [1.585-31.613]；p=0.010）、EPTB-DM（1.773 [1.165-2.698]；p=0.008）、无正规（2.266 [1.254-4.095]；p=0.001）和中等教育程度（1.889 [1.085-3.288]；p=0.025）是治疗结果不佳的统计学上显著的危险因素。EPTB 风险患者更有可能是女性（1.524 [1.311-1.746]；p<0.001）、马来人（1.251 [1.056-1.482]；p=0.010）和印度人（1.450 [1.142-1.842]；p=0.002）、TB-HIV（3.215 [2.347-4.405]；p<0.001）、EPDM-HIV（4.361 [1.657-11.474]；p=0.003）、EPTB-HIV-HEP（4.083 [2.785-5.987]；p<0.001）、居住在城市地区（1.272 [1.109-1.459]；p=0.001）和无正规教育（1.361 [1.018-1.820]；p=0.037）。
本研究的结果扩展了 EPTB 流行病学的知识，并强调需要在马来西亚改善 EPTB 的检测，特别是在 EPTB 和治疗结果不佳风险较高的亚人群中。
