Arzu TARAKÇI, Esma EROĞLU, Fatma ÇÖLKESEN, Fatma KACAR, Şule ÖZDEMİR ARMAĞAN, Selver CAN

The evaluation of the cases with extrapulmonary tuberculosis

Objective: Tuberculosis (TB) that can involve all organs is a disease progressing with a wide range of clinical presentations. It is especially difficult to diagnose the cases of extrapulmonary tuberculosis (EPTB) due to the atypical course, and the cases of EPTB constitute approximately 35% of all TB cases in our country. In our study, it was aimed to examine the distribution rates, diagnostic methods, and treatment processes of EPTB in terms of the involved systems. Material-Method: Of 308 patients diagnosed with TB, 119 cases having EPTB were retrospectively analyzed in The Konya Training and Research Hospital of Health Sciences University between 1st January 2015 and 30th June 2019. Results: While 119 (38.6%) EPTB cases of 308 cases diagnosed with TB were included in the study. 63 (52.9%) and 56 (47%) patients were women and men, respectively. The average age was found as 44.42±18.8 years (min: 18- max: 91 years). The distribution of involvement sites of EPTB was as follows: lymphadenitis, 45.3%; pleural tuberculosis, 24.3%; peritonitis, 14.2%; bone-joint tuberculosis, 7.5%; meningitis, 2.5%; miliary tuberculosis, 1.6%; others, 4.2%. In terms of EPTB, 83 (69.7%) cases were diagnosed histopathologically, 28 (23.5%) and nine (7.5%) were found to have culture and acido-resistant bacilli (ARB) positivity, respectively. A total of 29 (24.3%) cases were diagnosed microbiologically, and the purified protein derivative (PPD) positivity was detected in 106 (89%) cases. While the success rate of the treatment was found to be 93.2%, the mortality rate was measured as 3.3%. Conclusion: It should be kept in mind that TB is a common multisystem disease in our country and may present itself with a wide range of symptoms. In the presence of clinical suspicion, supportive tests should be performed; biopsy and culture samples should be obtained from the appropriate tissues; anti-TB treatment should be initiated at once if clinicians have sufficient evidence.

Keywords:

Extrapulmonary tuberculosis, lymphadenitis, pleural tuberculosis, histopathological, microbiological,

PDF

___

Tüberküloz Tanı ve Tedavi Rehberi, 2. Baskı Ankara, Mayıs 2019.
Aisenberg GM, Jacobson K, Chemaly RF, et al. Extrapulmonary tuberculosis active infection misdiagnosed as cancer. Cancer 2005; 104: 2882-7.
World Health Organization (2013) Global Tuberculosis Report 2013. Geneva: World Health Organization. Available: http://apps.who.int. 24 December 2014.
Bass JB, Farer LS, Hopewell PC.Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis 1990; 142: 725-35.
İnönü H, Köseoğlu D, Pazarlı C, et al. Bir üniversite hastanesinde takip edilen ekstrapulmoner tüberkülozlu olguların özellikleri. Tur Toraks Der 2010; 11: 167-72.
Öztop A, Ünsal İ, Özgü A, et al. Doksanbeş erişkin akciğer dışı tüberküloz olgusu. Solunum Hastalıkları 2004; 15: 34-42.
Özdemir M. Retrospective Evaluation of patients applied to tuberculosis dispensary in Osmaniye. TJFMPC 2020; 14; 252-9.
Demiralay R. Isparta ili verem savaş dispanserlerinde kayıtlı akciğer dışı organ tüberkülozunun bazı epidemiyolojik özellikleri. Tüberküloz ve Toraks Derg 2003; 51: 33-9.
Türkiye’de Verem Savaşı 2017 Raporu, T.C. Sağlık Bakanlığı Verem Savaşı Dairesi Başkanlığı. Ankara 2017. Erişim: https://hsgm.saglik.gov.tr/depo/haberler/verem-savas-raporu-2016-2017/Turkiyede Verem Savasi 2017 Raporu.pdf
Rieder HL, Snider DE, Cauthen GM. Extrapulmonary tuberculosis in the United States. Am Rev Respir Dis 1990; 141: 347-51.
Tavusbay N, Aksel N, Çakan A, Gülerçe G, Dereli Ş, Özsöz A. Ekstrapulmoner tüberkülozlu olgularımız. Solunum Hastalıkları 2000; 11: 294-8.
Kalaç N, Baflay N, Mutluay Nİ, Bayız H, Özkul M. Ekstrapulmoner tutulum gösteren tüberküloz olguları. Tüberküloz ve Toraks 1999; 47: 213- 5.
Tatar D, Alptekin S, Coşkunol İ, Aydın M. Lenf bezi tüberkülozlu olguların özellikleri. Solunum Hastalıkları 2007; 18: 20-5.
Aslan G, Ülger M, Delialioğlu N, et al. Mersin ilindeki akciğer dışı tüberküloz olgularının mikrobiyolojik ve demografik olarak değerlendirilmesi. Türk Mikrobiyol Cem Derg 2017; 47: 197-204.
Kolsuz M, Ersoy S, Demircan N, Metintaş M, Erginel S, Uçgun İ. Eskişehir-Deliklitaş Verem Savaş Dispanseri’nde izlenen akciğer dışı tüberküloz olgularının değerlendirilmesi. Toraks Derg 2003; 4: 25-32.
Şirin Y, Coşkunol Ü. Yüz yetmiş üç ekstrapulmoner TB olgusu. Tüberküloz ve Toraks Derg 2002; 50: 272-7.
Demir T, Çelik E, Antmen E. Çocuk tüberkülozu olgularının retrospektif olarak incelenmesi. Solunum hastalıkları 1999; 10: 384-91.
Kurt A, Poyrazoğlu G, Turgut M, et al. Tüberküloz tanısı ile izlenen hastaların klinik ve laboratuar özellikleri. Fırat Tıp Derg 2006; 11: 55-7.
Gönlügür T, Başol G, Gönlügür U, Kütük B. İlimiz dispanserlerinde takip edilen tüberküloz olgularının değerlendirilmesi. İzmir Göğüs Hastanesi Derg 2016; 3: 143-8.
Şengül A, Ogan N, Aydemir Y. Akciğer dışı tüberküloz: Kocaeli Verem Savaş Dispanseri’nde takip edilen 331 olgunun retrospektif incelenmesi. Med J Kocaeli 2015; 4: 4-9.
Yılmaz M, Yılmaz A. Düzce Toplum Sağlığı Merkezi Tüberküloz Birimi’ne kayıtlı tüberküloz vakalarının değerlendirilmesi: 2011-2015. Düzce Tıp Fakültesi Derg 2016; 18: 18-22.
Arıbaş ET, Yılmaz A, Erayman İ, Bitirgen M. Tüberküloz menenjit: 38 olgunun değerlendirilmesi, Turkiye Klinikleri J Med Sci 1999; 19: 156-60.
Doğanay M, Aygen B. Tüberküloz menenjit ve tedavisi. İnfeks Bül 1996;1: 17-20.
Matsushima T. Miliary tuberculosis or disseminated tuberculosis. Int Med 2005; 44: 687.