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Epidemiology and factors associated with Extra-pulmonary tuberculosis in a Low-prevalence area
Open accessAbstract
Background: Tuberculosis is a global public health problem. Extra-pulmonary tuberculosis accounts for an increasing proportion of cases worldwide, although information about epidemiological, clinical, or microbiological factors is lacking. Methods: We conducted a retrospective observational study of tuberculosis cases diagnosed between 2016 and 2021, classified into Pulmonary and Extra-pulmonary tuberculosis. Univariable and multivariable logistic regression models were used to investigate risk factors of Extra-pulmonary tuberculosis. Results: 20.9% of overall cases were classified as Extra-pulmonary tuberculosis, with a rising trend from 22.6% in 2016 to 27.9% in 2021. Lymphatic tuberculosis accounted for 50.6% of cases, followed by pleural tuberculosis (24.1%). 55.4% of cases belonged to foreign-born patients. Microbiological culture tested positive in 92.8% of Extra-pulmonary cases. Logistic regression analysis showed that women were more predisposed to develop Extra-pulmonary tuberculosis (aOR 2.46, 95% CI 1.45-4.20) as well as elderly patients (aged ≥ 65 years) (aOR 2.47, 95% CI 1.19-5.13) and persons with previous history of tuberculosis (4.99, 95% CI 1.40-17.82). Conclusions: Extra-pulmonary Tuberculosis have increased within our study period. A profound decline occurred in 2021 tuberculosis cases, probably due to COVID-19. Women, elderly population, and persons with previous history of tuberculosis are at higher risk of developing Extra-pulmonary tuberculosis in our setting.
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“Our study found that 16.5% of all TB cases were epTB, which is lower to rates found in other developed countries like the Netherlands (38%), the United States (27%), and Germany (21.6%), as reported by Rolo et al.14.”
From Prevalence of extrapulmonary tuberculosis and factors influencing successful treatment outcomes among notified cases in South India (2025) · cites this paper as [14]
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Hogan, A. B., Jewell, B. L., Sherrard-Smith, E., Vesga, J. F., Watson, O. J., Whittaker, C., Hamlet, A., Smith, J. A., Winskill, P., Verity, R., et al. (2020) · The Lancet Global Health · doi:10.1016/s2214-109x(20)30288-6 · Cited by 900
Epidemiology of Extrapulmonary Tuberculosis in the United States, 1993–2006
Peto, H. M., Pratt, R. H., Harrington, T. A., LoBue, P. A., & Armstrong, L. R. (2009) · Clinical Infectious Diseases · doi:10.1086/605559 · Cited by 741
Sharma, S. K., Mohan, A., & Kohli, M. (2021) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2021.1927718 · Cited by 441
The WHO Global Tuberculosis 2021 Report – not so good news and turning the tide back to End TB
Chakaya, J., Petersen, E., Nantanda, R., Mungai, B. N., Migliori, G. B., Amanullah, F., Lungu, P., Ntoumi, F., Kumarasamy, N., Maeurer, M., et al. (2022) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2022.03.011 · Cited by 405
Identification of Risk Factors for Extrapulmonary Tuberculosis
Yang, Z., Kong, Y., Wilson, F., Foxman, B., Fowler, A. H., Marrs, C. F., Cave, M. D., & Bates, J. H. (2004) · Clinical Infectious Diseases · doi:10.1086/380644 · Cited by 388
Tuberculosis surveillance and monitoring in Europe 2019 - 2017 data.
Dadu, A., Dara, M., Ehsani, S., Gozalov, O., Hovanesyan, A., Ködmön, C., Molnarova, B., van den Boom, M., & van der Werf, M. J. (2019) · Cited by 350
Dheda, K., Perumal, T., Moultrie, H., Perumal, R., Esmail, A., Scott, A. J., Udwadia, Z., Chang, K. C., Peter, J., Pooran, A., et al. (2022) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(22)00092-3 · Cited by 292
Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008–2017
Pang, Y., An, J., Shu, W., Huo, F., Chu, N., Gao, M., Qin, S., Huang, H., Chen, X., & Xu, S. (2019) · Emerging Infectious Diseases · doi:10.3201/eid2503.180572 · Cited by 282
Sreeramareddy, C. T., Panduru, K. V., Verma, S. C., Joshi, H. S., & Bates, M. (2008) · BMC Infectious Diseases · doi:10.1186/1471-2334-8-8 · Cited by 242
Extrapulmonary tuberculosıs: an old but resurgent problem
BAYKAN, A. H., Sayıner, H. S., Aydın, E., Koç, M., İnan, İ., & Ertürk, Ş. M. (2022) · Insights into Imaging · doi:10.1186/s13244-022-01172-0 · Cited by 176
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Tuberculous pleuritis: clinical presentations and diagnostic challenges
Chan, K. K. P., & Lee, G. (2024) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0000000000001052 · Cited by 37
VidyaRaj, C. K., Vadakunnel, M. J., Mani, B. R., Anbazhagi, M., Pradhabane, G., Venkateswari, R., Palavesam, S., Venkatesh, K., Usharani, B., Sriramkumar, S. R., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-92613-5 · Cited by 31
“Our study found that 16.5% of all TB cases were epTB, which is lower to rates found in other developed countries like the Netherlands (38%), the United States (27%), and Germany (21.6%), as reported by Rolo et al. 14 .”
InfluentialHost- and pathogen-related determinants of pulmonary versus extrapulmonary tuberculosis
Tulu, B., Brehm, T. T., van Crevel, R., Dallenga, T. K., DiNardo, A. R., Dheda, K. U. J., Eggeling, J., Enbiale, W., Gröschel, M. I., Hao, J., et al. (2026) · European Respiratory Review · doi:10.1183/16000617.0174-2025 · Cited by 12
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Baker, H., Amaral, J. K., & Schoen, R. T. (2024) · Current Opinion in Rheumatology · doi:10.1097/bor.0000000000001009 · Cited by 8
Risk Factors for Extrapulmonary Tuberculosis Among US Veterans, 1990–2022
Oda, G., Lucero-Obusan, C. A., Schirmer, P., Chung, J. S., & Holodniy, M. (2024) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofae698 · Cited by 8
Metadata
- Authors
- Rolo, M., González-Blanco, B., Reyes, C. A., Rosillo, N., & López-Roa, P.
- Affiliations
- Hospital Universitario 12 De Octubre (ES)
- Corresponding author
- López-Roa, P.
- Venue
- Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
- Publisher
- Elsevier BV
- Published
- 2023-08
- Volume
- 32
- Pages
- 100377
- ISSN
- 2405-5794 (ISSN-L)
- PMC
- PMC10209530
- OpenAlex
- W4376279658
- Cited by
- 85
- References
- 24
- Citations by year
- 2026: 22 · 2025: 30 · 2024: 31 · 2023: 1
- FWCI
- 17.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- www.elsevier.com/legal/tdmrep-license (tdm)
- creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
- Locations
- Journal of Clinical Tuberculosis and Other Mycobacterial Diseases (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- European Commission
- Instituto de Salud Carlos III (PI21/01738)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Infectious Diseases › Diagnosis and treatment of tuberculosis
- Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
- Keywords
- extrapulmonary tuberculosis, pulmonary tuberculosis, tuberculous lymphadenitis, pleural tuberculosis, risk factors, sex differences, elderly patients, history of tuberculosis, foreign-born patients, tuberculosis incidence trends, low-prevalence areas
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- Rolo, M., González-Blanco, B., Reyes, C. A., Rosillo, N., & López-Roa, P. (2023). Epidemiology and factors associated with Extra-pulmonary tuberculosis in a Low-prevalence area. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. https://doi.org/10.1016/j.jctube.2023.100377
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