Pathogen and host determinants of extrapulmonary tuberculosis among 1035 patients in Frankfurt am Main, Germany, 2008-2023.

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection Pub Date : 2024-11-09 DOI:10.1016/j.cmi.2024.11.009

Natalia Rachwal, Raja Idris, Viola Dreyer, Elvira Richter, Thomas A Wichelhaus, Stefan Niemann, Nils Wetzstein, Udo Götsch

{"title":"Pathogen and host determinants of extrapulmonary tuberculosis among 1035 patients in Frankfurt am Main, Germany, 2008-2023.","authors":"Natalia Rachwal, Raja Idris, Viola Dreyer, Elvira Richter, Thomas A Wichelhaus, Stefan Niemann, Nils Wetzstein, Udo Götsch","doi":"10.1016/j.cmi.2024.11.009","DOIUrl":null,"url":null,"abstract":"Objectives: Extrapulmonary tuberculosis (EPTB) presents with nonspecific symptoms which can pose a significant diagnostic challenge. Various factors, including age, sex, and HIV status, have been associated with an increased risk of developing EPTB. However, the influence of the lineage of the infecting Mycobacterium tuberculosis complex (Mtbc) strain remains controversial.Methods: Between 2008 and 2023, comprehensive clinical data from 1035 cases, along with whole genome sequencing (WGS) data of the respective Mtbc strains have been collected. To examine the association between Mtbc lineage and EPTB, we calculated crude and adjusted odds ratios (OR) using logistic regression and performed propensity score matching with a subset of the cohort.Results: Of the 1035 patients, 272 had exclusively extrapulmonary disease and 138 had both pulmonary and extrapulmonary disease. Patients infected with a lineage 1 strain had the highest odds of developing EPTB in the univariate analysis (OR: 3.30, 95% CI: 1.97-5.49). However, Mtbc lineage was not a significant predictor in the multivariable model, while the odds of developing extrapulmonary disease were higher among patients born in the South-East Asian region (adjusted OR: 6.00, 95% CI: 3.41-10.69) and the Eastern Mediterranean Region (adjusted OR: 5.95, 95% CI: 3.61-9.96) compared to those born in the European region. Further, female sex and age were significant positive predictors for EPTB.Conclusions: Our results demonstrate that host factors, such as geographic origin, age and sex are stronger predictors for EPTB than infection with a Mtbc strain of a particular lineage. Further investigation of this host-pathogen interaction is needed.","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9000,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Microbiology and Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cmi.2024.11.009","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: Extrapulmonary tuberculosis (EPTB) presents with nonspecific symptoms which can pose a significant diagnostic challenge. Various factors, including age, sex, and HIV status, have been associated with an increased risk of developing EPTB. However, the influence of the lineage of the infecting Mycobacterium tuberculosis complex (Mtbc) strain remains controversial.

Methods: Between 2008 and 2023, comprehensive clinical data from 1035 cases, along with whole genome sequencing (WGS) data of the respective Mtbc strains have been collected. To examine the association between Mtbc lineage and EPTB, we calculated crude and adjusted odds ratios (OR) using logistic regression and performed propensity score matching with a subset of the cohort.

Results: Of the 1035 patients, 272 had exclusively extrapulmonary disease and 138 had both pulmonary and extrapulmonary disease. Patients infected with a lineage 1 strain had the highest odds of developing EPTB in the univariate analysis (OR: 3.30, 95% CI: 1.97-5.49). However, Mtbc lineage was not a significant predictor in the multivariable model, while the odds of developing extrapulmonary disease were higher among patients born in the South-East Asian region (adjusted OR: 6.00, 95% CI: 3.41-10.69) and the Eastern Mediterranean Region (adjusted OR: 5.95, 95% CI: 3.61-9.96) compared to those born in the European region. Further, female sex and age were significant positive predictors for EPTB.

Conclusions: Our results demonstrate that host factors, such as geographic origin, age and sex are stronger predictors for EPTB than infection with a Mtbc strain of a particular lineage. Further investigation of this host-pathogen interaction is needed.

查看原文本刊更多论文

2008-2023 年德国美因河畔法兰克福 1035 名患者肺外结核病的病原体和宿主决定因素。

目的：肺外结核（EPTB）表现为非特异性症状，给诊断带来很大挑战。包括年龄、性别和艾滋病病毒感染状况在内的各种因素都与肺结核发病风险的增加有关。然而，感染结核分枝杆菌复合菌株（Mtbc）血统的影响仍存在争议：方法：从 2008 年到 2023 年，我们收集了 1035 个病例的全面临床数据以及相应 Mtbc 菌株的全基因组测序（WGS）数据。为了研究Mtbc菌株与EPTB之间的关系，我们采用逻辑回归法计算了粗略和调整后的几率比（OR），并对队列中的一个子集进行了倾向得分匹配：在 1035 名患者中，272 人仅患有肺外疾病，138 人同时患有肺内和肺外疾病。在单变量分析中，感染 1 系菌株的患者患 EPTB 的几率最高（OR：3.30，95% CI：1.97-5.49）。然而，在多变量模型中，Mtbc 株系并不是一个重要的预测因素，而与欧洲地区出生的患者相比，东南亚地区（调整后 OR：6.00，95% CI：3.41-10.69）和东地中海地区（调整后 OR：5.95，95% CI：3.61-9.96）出生的患者罹患肺外疾病的几率更高。此外，女性性别和年龄也是预测 EPTB 的重要积极因素：我们的研究结果表明，宿主因素（如地理来源、年龄和性别）比感染特定血统的Mtbc菌株更能预测EPTB。我们需要进一步研究宿主与病原体之间的相互作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.