Grønningen Erlend, Nanyaro Marywinnie, Ngadaya Esther, Mustafa Tehmina
Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
PLoS One. 2025 Mar 25;20(3):e0320691. doi: 10.1371/journal.pone.0320691. eCollection 2025.
Unlike pulmonary tuberculosis, there is limited information on delays in diagnosis and treatment initiation in extrapulmonary tuberculosis (EPTB) and their consequences for disease outcomes and mortality. In low- and middle-income countries, most EPTB cases are presumed rather than microbiologically confirmed, which might lead to an underestimation of the mortality rates in EPTB.
The study aimed to assess the delays in diagnosis and treatment in EPTB and their association with mortality in a setting with a high prevalence of both HIV and malnutrition.
We included 106 EPTB patients from Mbeya Zonal Referral Hospital, who were followed up until the completion of their treatment. Patients were classified as having EPTB using a clinical case definition. In total, 37 of 106 (35%) EPTB cases resulted in death. The median (interquartile range) total diagnostic delay for survivors was 59 days (26-136), while for those who died, it was 78 days (32-165). The corresponding median (interquartile range) treatment delay was 66 days (33-140) for survivors and 78 days (27-189) for those who died. None of the differences reached statistical significance when analyzed with non-parametric tests. Surprisingly, 21 patients did not receive TB treatment, but this lack of therapy did not affect mortality or correlate with a longer diagnostic delay.
We were unable to demonstrate that diagnostic or treatment delays were higher in EPTB patients who died. Furthermore, EPTB patients who did not receive TB treatment did not exhibit higher mortality rates. Further prospective studies with larger sample sizes are needed to better understand the factors contributing to delays in diagnosis and treatment, as well as their potential impact on mortality in EPTB.
与肺结核不同，关于肺外结核（EPTB）诊断和治疗起始延迟及其对疾病转归和死亡率影响的信息有限。在低收入和中等收入国家，大多数EPTB病例是推定的而非经微生物学确诊，这可能导致对EPTB死亡率的低估。
本研究旨在评估在艾滋病毒和营养不良高流行环境下EPTB的诊断和治疗延迟及其与死亡率的关联。
我们纳入了来自姆贝亚地区转诊医院的106例EPTB患者，对其进行随访直至治疗结束。采用临床病例定义将患者分类为患有EPTB。106例EPTB病例中共有37例（35%）死亡。幸存者的总诊断延迟中位数（四分位间距）为59天（26 - 136天），而死亡患者为78天（32 - 165天）。幸存者的相应治疗延迟中位数（四分位间距）为66天（33 - 140天），死亡患者为78天（27 - 189天）。采用非参数检验分析时，这些差异均未达到统计学显著性。令人惊讶的是，21例患者未接受结核病治疗，但这种治疗缺失并未影响死亡率，也与更长的诊断延迟无关。
我们未能证明死亡的EPTB患者的诊断或治疗延迟更长。此外，未接受结核病治疗的EPTB患者并未表现出更高的死亡率。需要进一步开展更大样本量的前瞻性研究，以更好地了解导致诊断和治疗延迟的因素及其对EPTB死亡率的潜在影响。
