Extrapulmonary tuberculosis in The Netherlands, an epidemiologic overview, 1993–2022

IF 2 Q3 INFECTIOUS DISEASES

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Pub Date : 2025-06-26 DOI:10.1016/j.jctube.2025.100546

Frouke A. Procee , Jizzo R. Bosdriesz , Frank G.J. Cobelens , Maria Prins , Sabine M. Hermans , Anton E. Kunst

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Abstract

Background

Extrapulmonary tuberculosis (EPTB) poses significant diagnostic and therapeutic challenges in low-incidence settings like the Netherlands. Despite declining overall tuberculosis (TB) incidence, the proportion of EPTB has risen, especially among migrant populations. This study examines sociodemographic, migration-related, and clinical factors associated with EPTB from 1993 to 2022 to inform TB diagnostics and care.

Methods

A retrospective quantitative analysis of 34,048 TB patients reported to the Netherlands Tuberculosis Registry (1993–2022) was conducted. Logistic regression was used to identify associations with EPTB. Temporal trends in EPTB and pulmonary TB (PTB) were evaluated, including stratification by age, country of birth, and duration of residency.

Results

Over the study period, the proportion of EPTB rose from 37 % to 50 %. EPTB was more common in women (adjusted odds ratio (aOR) 1.53; 95 % CI 1.45–1.62) and children under 14 years (aOR 2.83; 95 % CI 2.46–3.24). Foreign-born individuals, particularly from India, Somalia, Eritrea, Ethiopia and Pakistan, had higher odds of EPTB compared to Dutch-born individuals (aOR range: 2.33–3.86). EPTB was also associated with HIV infection (aOR 1.73; 95 % CI 1.43–2.11) but inversely related to social risk factors like homelessness and problem substance use. TB was notably frequently diagnosed among individuals residing in the Netherlands for over 10 years, more often EPTB than PTB.

Conclusion

The rising proportion of EPTB underscores the need for targeted interventions, particularly for high-risk groups such as women, children and migrants. Enhanced screening, early detection, and preventive strategies, especially for tuberculosis infection (TBI) are critical to reducing EPTB morbidity and mortality.

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荷兰1993-2022年肺外结核流行病学综述

背景：在荷兰等低发病率地区，肺痨（EPTB）的诊断和治疗面临重大挑战。尽管结核病的总发病率有所下降，但EPTB的比例却有所上升，尤其是在移民人群中。本研究调查了1993年至2022年与EPTB相关的社会人口统计学、移民相关和临床因素，为结核病诊断和治疗提供信息。方法对荷兰结核病登记处1993-2022年报告的34048例结核病患者进行回顾性定量分析。使用逻辑回归来确定与EPTB的关联。对EPTB和肺结核（PTB）的时间趋势进行了评估，包括年龄、出生国家和居住时间的分层。结果在研究期间，EPTB的比例从37%上升到50%。EPTB在女性中更为常见(调整优势比（aOR） 1.53；95% CI 1.45-1.62)和14岁以下儿童(aOR 2.83；95% ci 2.46-3.24)。外国出生的人，特别是来自印度、索马里、厄立特里亚、埃塞俄比亚和巴基斯坦的人，与荷兰出生的人相比，患EPTB的几率更高（aOR范围：2.33-3.86）。EPTB还与HIV感染相关(aOR 1.73；95% CI 1.43-2.11)，但与无家可归和问题物质使用等社会风险因素呈负相关。结核病在荷兰居住10年以上的人群中被诊断出来的频率很高，EPTB比PTB更常见。结论EPTB比例的上升强调了有针对性干预的必要性，特别是对妇女、儿童和移民等高危人群。加强筛查、早期发现和预防策略，特别是结核病感染（TBI），对于降低EPTB发病率和死亡率至关重要。

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

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine

CiteScore

4.00

自引率

5.00%

发文量

审稿时长

30 weeks

期刊介绍： Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.