Clinical heterogeneity and treatment outcomes of extrapulmonary tuberculosis in a low-incidence setting: insights from a prospective cohort study.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-03-11 DOI:10.1007/s15010-025-02500-4

Angela Klingmüller, Marie Feldmann, Samuel Rohr, Lea Helmhold, Lena Junker, Margarete Scherer, Jörg-Janne Vehreschild, Kirsten Schmidt-Hellerau, Ada Hoffmann, Jonathan Jantsch, Alexander Simonis, Victor Suárez, Dominic Rauschning, Natalie Funke, Jakob J Malin, Lena M Biehl, Philipp Schommers, Gerd Fätkenheuer, Clara Lehmann, Jan Rybniker, Isabelle Suárez

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引用次数: 0

Abstract

Purpose: Tuberculosis (TB) remains a leading cause of morbidity and mortality, with 1.3 million deaths in 2022. Extrapulmonary tuberculosis (EPTB) accounts for approximately 20% of all TB cases. We assessed the clinical presentation and challenges during the course of treatment in EPTB patients in a low-incidence setting.

Methods: We conducted a prospective cohort study involving 44 EPTB patients at the University Hospital of Cologne, Germany. Clinical data were collected before and during treatment.

Results: The cohort comprised 44 patients originating from 21 countries. Two or more invasive procedures were required for microbiological confirmation in 59% (26/44) of the cases. Sputum culture was positive in 18% (8/44) of patients, with 63% (5/8) showing no radiological signs of pulmonary involvement. The median therapy duration was ten months and increased with disease severity. Paradoxical reactions (PR) occurred in 31% (13/42) of the patients. A previously published clinical scoring system assessing EPTB treatment responses showed a favorable treatment outcome in only 68% (21/31) of the patients in this cohort.

Conclusion: EPTB exhibits highly variable disease severity and organ involvement. Treatment initiation is often delayed due to diagnostic challenges. Management is complicated by the frequent occurrence of PR, which can lead to treatment durations exceeding standard recommendations. Clinical scores for treatment response assessment may not be reliably applicable, highlighting the need for alternative biomarkers.

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低发病率环境下肺外结核的临床异质性和治疗结果：来自前瞻性队列研究的见解

目的：结核病（TB）仍然是发病率和死亡率的主要原因，2022年有130万人死亡。肺外结核（EPTB）约占所有结核病例的20%。我们评估了EPTB患者在低发病率环境下的临床表现和治疗过程中的挑战。方法：我们在德国科隆大学医院进行了一项涉及44例EPTB患者的前瞻性队列研究。在治疗前和治疗期间收集临床资料。结果：该队列包括来自21个国家的44名患者。59%（26/44）的病例需要两次或两次以上的侵入性手术进行微生物学确认。18%（8/44）的患者痰培养呈阳性，63%（5/8）的患者没有肺部受累的影像学征象。中位治疗时间为10个月，随着疾病严重程度的增加而延长。31%（13/42）的患者出现矛盾反应（PR）。先前发表的评估EPTB治疗反应的临床评分系统显示，该队列中只有68%（21/31）的患者有良好的治疗结果。结论：EPTB表现出高度可变的疾病严重程度和器官累及。由于诊断方面的困难，治疗开始往往被推迟。由于PR的频繁发生，治疗变得复杂，这可能导致治疗时间超过标准建议。用于治疗反应评估的临床评分可能不可靠，这突出了对替代生物标志物的需求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.