Epidemiology and clinicodemographic features of microbiologically confirmed and presumptive extrapulmonary tuberculosis in Ethiopia: a multicenter study

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions Pub Date : 2025-09-17 DOI:10.1016/j.ijregi.2025.100765

Hilina Mollalign , Shewki Moga , Dawit Chala , Muluwok Getahun , Habteyes Hailu Tola , Dereje Beyene

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Abstract

Objectives

To determine the magnitude and factors associated with extrapulmonary tuberculosis (EPTB) and examine differences in clinicodemographic features compared to presumptive EPTB.

Methods

A cross-sectional study was conducted between August 2022 and October 2023 to enroll 542 participants from eleven public hospitals. Microbiologic confirmations of EPTB were made using Xpert MTB/RIF-Ultra and TB culture. Clinicodemographic variables were described using frequency and compared using chi-square and regression statistics.

Result

The prevalence of culture-confirmed EPTB was 34.9% (95% confidence interval [CI]: 30.9-39.0). The mean platelet count distribution was higher among microbiologically confirmed EPTB (P <0.001), whereas leukocytosis and erythrocytopenia were significantly associated with presumptive EPTB (P <0.001), without differences in the mean hemoglobin concentration (P >0.05). However, the area under the curve (AUC) of hematological indices poorly distinguished presumptive and confirmed EPTB (AUC = 0.533-0.645). Previous TB treatment history (adjusted odds ratio [AOR] = 3.7, 95% CI: 1.9-6.9) and HIV coinfection (AOR = 3.1, 95% CI: 1.3-7.3) were predictors of microbiologically confirmed EPTB. Alcohol use (AOR = 1.7, 95% CI: 1.1-2.6), hospitalization (AOR = 2.5, 95% CI: 1.6-3.8), and any treatment nonadherence history (AOR = 1.9, 95% CI: 1.2-2.9) were significantly associated with presumptive EPTB.

Conclusions

The prevalence of EPTB in Ethiopia remains high. Most clinical features of presumptive and confirmed EPTB overlap, while there are slight differences in sociodemographic characteristics.

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埃塞俄比亚微生物学证实和推定肺外结核的流行病学和临床人口学特征：一项多中心研究

目的确定肺外结核（EPTB）的大小和相关因素，并检查与推定EPTB相比临床人口学特征的差异。方法于2022年8月至2023年10月进行横断面研究，从11家公立医院招募542名参与者。采用Xpert MTB/RIF-Ultra和结核培养对EPTB进行微生物学鉴定。临床人口学变量用频率描述，并用卡方统计和回归统计进行比较。结果培养确诊EPTB患病率为34.9%（95%可信区间[CI]: 30.9 ~ 39.0）。微生物学证实的EPTB中平均血小板计数分布较高（P <0.001），而白细胞增多和红细胞减少与假定的EPTB显著相关（P <0.001），平均血红蛋白浓度无差异（P < 0.05）。然而，血液学指标的曲线下面积（AUC）难以区分推定和确诊的EPTB （AUC = 0.533-0.645）。既往结核病治疗史（校正优势比[AOR] = 3.7, 95% CI: 1.9-6.9）和HIV合并感染（AOR = 3.1, 95% CI: 1.3-7.3）是微生物学证实的EPTB的预测因素。酒精使用（AOR = 1.7, 95% CI: 1.1-2.6）、住院（AOR = 2.5, 95% CI: 1.6-3.8）和任何治疗不依从史（AOR = 1.9, 95% CI: 1.2-2.9）与EPTB的推定显著相关。结论埃塞俄比亚EPTB的流行率仍然很高。推定和确诊的EPTB的大多数临床特征重叠，而社会人口统计学特征略有差异。

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