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

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.