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      Epidemiological characteristics and some risk factors of extrapulmonary tuberculosis in Larache, Morocco

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          Abstract

          Introduction

          this work aims to bring out the epidemiological characteristics of extrapulmonary tuberculosis (EPTB) in the province of Larache (Morocco) and to investigate the effect of gender and age on its localization and treatment outcome.

          Methods

          it consists in a retrospective study based on 2962 cases of EPTB, reported during the period 2000 to 2012.

          Results

          the mean age was 31.74 ± 18.83 years, with a median age of 26. Males are more affected by this form of tuberculosis, with a male to female sex-ratio of 1,15. The EPTB affects particularly the young population whose age is between 15 and 34 years. The pleural and lymph node localizations are the most common with 45% and 28% respectively. The statistical analysis reveals that younger patients are preferentially affected by lymph node tuberculosis whereas oldest ones are more likely to suffer from urogenital and pericardial tuberculosis. Regarding the treatment outcome, we demonstrated that age is significantly associated with the treatment outcome and that deaths occur preferentially in the oldest patients. Finally, we found out a significant association between males and pleural ETB localization, and between females and lymph node and peritoneo-itestinal ETB localizations.

          Conclusion

          special attention must be paid to the mentioned most vulnerable categories of EPTB patients.

          Most cited references24

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          Identification of risk factors for extrapulmonary tuberculosis.

          The proportion of extrapulmonary tuberculosis cases in the United States has increased from 16% of tuberculosis cases, in 1991, to 20%, in 2001. To determine associations between the demographic, clinical, and life style characteristics of patients with tuberculosis and the occurrence of extrapulmonary tuberculosis, a retrospective case-control study was conducted. This study included 705 patients with tuberculosis, representing 98% of the culture-proven cases of tuberculosis in Arkansas from 1 January 1996 through 31 December 2000. A comparison between 85 patients with extrapulmonary tuberculosis (case patients) and 620 patients with pulmonary tuberculosis (control patients) showed women (OR, 1.98; 95% CI, 1.25-3.13), non-Hispanic blacks (OR, 2.38; 95% CI, 1.42-3.97), and HIV-positive persons (OR, 4.93; 95% CI, 1.95-12.46) to have a significantly higher risk for extrapulmonary tuberculosis than men, non-Hispanic whites, and HIV-negative persons. This study expands the knowledge base regarding the epidemiology of extrapulmonary tuberculosis and enhances our understanding of the relative contribution of host-related factors to the pathogenesis of tuberculosis.
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            Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection.

            To evaluate the relationship between the clinical presentation of tuberculosis and the CD4 cell count in patients with human immunodeficiency virus (HIV) infection, we evaluated clinical and laboratory features of 97 HIV-infected patients with tuberculosis in whom CD4 cell counts were available. Extrapulmonary tuberculosis was found in 30 (70%) of 43 patients with 300 CD4 cells/microL (p = 0.02). Mycobacteremia was found in 18 (49%) of 37 patients with 300 CD4 cells/microL (p = 0.002). Acid-fast smears were more often positive in patients with low CD4 cell counts. Positive tuberculin skin tests were more common in patients with high CD4 counts. On chest roentgenograms, mediastinal adenopathy was noted in 20 (34%) of 58 patients with 200 CD4 cells/microL (p = 0.04). Pleural effusions were noted in six (10%) of 58 patients with 200 CD4 cells/microL (p = 0.04). The CD8 cell counts did not correlate with the manifestations of tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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              Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study

              Background Studies from developed countries have reported on host-related risk factors for extra-pulmonary tuberculosis (EPTB). However, similar studies from high-burden countries like Nepal are lacking. Therefore, we carried out this study to compare demographic, life-style and clinical characteristics between EPTB and PTB patients. Methods A retrospective analysis was carried out on 474 Tuberculosis (TB) patients diagnosed in a tertiary care hospital in western Nepal. Characteristics of demography, life-style and clinical features were obtained from medical case records. Risk factors for being an EPTB patient relative to a PTB patient were identified using logistic regression analysis. Results The age distribution of the TB patients had a bimodal distribution. The male to female ratio for PTB was 2.29. EPTB was more common at younger ages (< 25 years) and in females. Common sites for EPTB were lymph nodes (42.6%) and peritoneum and/or intestines (14.8%). By logistic regression analysis, age less than 25 years (OR 2.11 95% CI 1.12–3.68) and female gender (OR 1.69, 95% CI 1.12–2.56) were associated with EPTB. Smoking, use of immunosuppressive drugs/steroids, diabetes and past history of TB were more likely to be associated with PTB. Conclusion Results suggest that younger age and female gender may be independent risk factors for EPTB in a high-burden country like Nepal. TB control programmes may target young and female populations for EPTB case-finding. Further studies are necessary in other high-burden countries to confirm our findings.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                31 August 2020
                2020
                : 36
                : 381
                Affiliations
                [1 ]Faculty of Sciences, Ibn Tofaïl University, Kenitra, Morocco,
                [2 ]Royal Institute of Managers Training, Sale, Morocco
                Author notes
                Corresponding author: Amine Arfaoui, Royal Institute of Managers Training, Sale, Morocco. amine_arfaoui@ 123456yahoo.fr
                Article
                PAMJ-36-381
                10.11604/pamj.2020.36.381.24870
                7666704
                33235658
                8c1720a4-8afe-4cd1-93f6-2b03fd541d94
                Copyright: Adil Sbayi et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 July 2020
                : 29 July 2020
                Categories
                Research

                Medicine
                extrapulmonary tuberculosis,larache,epidemiology,risk factors
                Medicine
                extrapulmonary tuberculosis, larache, epidemiology, risk factors

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