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Cited by 13Tuberculosis Research and EpidemiologyDiagnosis and treatment of tuberculosisInfectious Diseases and Tuberculosis

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Analysis of epidemiological characteristics of extrapulmonary tuberculosis from South-Central China

Open access
Yu, Yanyan, Xiang, Yu, Liu, Haican, Yang, Shuliu, Li, Machao, Liu, Binbin, Xu, Da, Wu, Yaning, Li, Wenbin, Fang, Tanwei, Li, Jixiang, Xu, Donglei, Wan, Kanglin, Tan, Yunhong, Yuan, Xiuqin, Li, Guilian·2024·Frontiers in Public Health
DOI 10.3389/fpubh.2024.1405358PMC PMC11288871
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Abstract

Objectives: This study aimed to investigate the epidemiological and drug resistance (DR) characteristics of extrapulmonary tuberculosis (EPTB) in South-Central China. Methods: EPTB inpatients who were culture-positive for Mycobacterium tuberculosis were retrospectively included in a study at a provincial TB hospital in Hunan, a province in South-Central China, from January 2013 to December 2021. Demographic, clinical, and drug susceptibility data were retrieved from TB treatment records. Descriptive statistical methods and a Chi-squared test were used to analyze the epidemiological and DR characteristics of EPTB patients. A logistic regression model was used to explore the risk factors of rifampicin-resistant/multidrug-resistant (RR/MDR)-EPTB. Results: A total of 1,324 cases were included. The majority of EPTB patients were in the age range of 20–29 years, were predominantly men (male-to-female ratio: 2.03), and were farmers (65.63%). Most EPTB cases were found in 2013 and 2017 from 2013 to 2021. The most prevalent subtypes of EPTB were lymphatic TB (29.83%, 395/1,324), multiple EPTB (20.85%, 276/1,324), and musculoskeletal TB (14.65%, 194/1,324). Musculoskeletal TB and genitourinary TB predominantly presented as exclusive EPTB forms, while lymphatic TB and pharyngeal/laryngeal TB often co-occurred with pulmonary TB (PTB). Drug susceptibility testing results showed that total DR rates (resistance to any of RFP, isoniazid [INH], streptomycin [STR], and/or ethambutol [EMB]) and RR/MDR rates in EPTB were 25.23% and 12.39%, respectively. Musculoskeletal TB exhibited the highest rates of total DR (31.40%), INH resistance (28.90%), STR resistance (20.10%), EMB resistance (6.20%), MDR (13.90%), and poly-DR (6.70%). The multivariable logistic regression model showed that patients aged from 20 to 59 years (compared to those aged 10 years), workers (compared to retirees), and EPTB patients from the south and west of Hunan (compared to those from the east of Hunan) were at an increased risk of developing RR/MDR EPTB (all OR values > 1). Conclusion: Our study provided a detailed account of the epidemiological and DR characteristics of EPTB in Hunan province, China. The significant DR rates, particularly in musculoskeletal TB cases, highlight the need for timely diagnosis, effective drug susceptibility testing, and the development of more effective treatment regimens for EPTB, especially targeting musculoskeletal TB treatments.

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Figures

Figure 1 The distributions of extrapulmonary tuberculosis in Hunan, China, from 2013 to 2021. (A) Age distribution; (B) occupational distribution; (C) temporal distribution; and (D) spatial distribution.
Figure 1 The distributions of extrapulmonary tuberculosis in Hunan, China, from 2013 to 2021. (A) Age distribution; (B) occupational distribution; (C) temporal distribution; and (D) spatial distribution.CC BY · PubMed Central
Figure 2 The ranks of the proportion of subtypes of extrapulmonary tuberculosis in each age group (the proportion decreases from top to bottom) (TB, tuberculosis; EPTB, extrapulmonary tuberculosis. Multiple EPTB means that patients have more than one subtype of EPTB, not limited to the specific subtypes listed in this figure. Other EPTB means that patients did not have the specific subtypes of EPTB listed in this figure).
Figure 2 The ranks of the proportion of subtypes of extrapulmonary tuberculosis in each age group (the proportion decreases from top to bottom) (TB, tuberculosis; EPTB, extrapulmonary tuberculosis. Multiple EPTB means that patients have more than one subtype of EPTB, not limited to the specific subtypes listed in this figure. Other EPTB means that patients did not have the specific subtypes of EPTB listed in this figure).CC BY · PubMed Central
Figure 3 Drug resistance trends of extrapulmonary tuberculosis during 2013–2021 (STR, streptomycin; INH, isoniazid; RFP, rifampicin; EMB, ethambutol; MDR, multidrug resistance; total DR, total drug resistance, and it means that the isolates were resistant to any of RFP, INH, EMB, and/or STR).
Figure 3 Drug resistance trends of extrapulmonary tuberculosis during 2013–2021 (STR, streptomycin; INH, isoniazid; RFP, rifampicin; EMB, ethambutol; MDR, multidrug resistance; total DR, total drug resistance, and it means that the isolates were resistant to any of RFP, INH, EMB, and/or STR).CC BY · PubMed Central
Figure 4 The eight drug resistance rate distributions among age groups (STR, streptomycin; INH, isoniazid; RFP, rifampicin; EMB, ethambutol; MDR, multidrug resistance; total DR, total drug resistance, and it means the isolates were resistant to any of RFP, INH, EMB, and/or STR).
Figure 4 The eight drug resistance rate distributions among age groups (STR, streptomycin; INH, isoniazid; RFP, rifampicin; EMB, ethambutol; MDR, multidrug resistance; total DR, total drug resistance, and it means the isolates were resistant to any of RFP, INH, EMB, and/or STR).CC BY · PubMed Central
Figure 5 The drug resistance rates of the nine subtypes of extrapulmonary tuberculosis (TB, tuberculosis; EPTB, extrapulmonary tuberculosis; STR, streptomycin; INH, isoniazid; RFP, rifampicin; EMB, ethambutol; MDR, multidrug resistance; total DR, total drug resistance, and it means that the isolates were resistant to any of RFP, INH, EMB, and STR. Multiple EPTB means that patients have more than one subtype of EPTB, not limited to the specific subtypes listed in this figure. Other EPTB means that patients did not have the specific subtypes of EPTB listed in this figure).
Figure 5 The drug resistance rates of the nine subtypes of extrapulmonary tuberculosis (TB, tuberculosis; EPTB, extrapulmonary tuberculosis; STR, streptomycin; INH, isoniazid; RFP, rifampicin; EMB, ethambutol; MDR, multidrug resistance; total DR, total drug resistance, and it means that the isolates were resistant to any of RFP, INH, EMB, and STR. Multiple EPTB means that patients have more than one subtype of EPTB, not limited to the specific subtypes listed in this figure. Other EPTB means that patients did not have the specific subtypes of EPTB listed in this figure).CC BY · PubMed Central
Figure 6 Drug resistance comparisons between different subtypes of extrapulmonary tuberculosis. (1) STR resistance; (2) INH resistance; (3) RFP resistance; (4) EMB resistance; (5) MDR; (6) Total DR; (7) mono-DR; (8) poly-DR (*with a line means that the drug resistance rates between two groups were significantly different by one-by-one comparison [Bonferroni test]. * and ** after the subtitles means the resistance differences were statistically significant between/among groups, *means P < 0.05, **means P < 0.01. TB, tuberculosis; EPTB, extrapulmonary tuberculosis; STR, streptomycin; INH, isoniazid; RFP, rifampicin; EMB, ethambutol; MDR, multidrug resistance; total DR, total drug resistance, and it means that the isolates were resistant to any of RFP, INH, EMB, and/or STR. Multiple EPTB means that patients have more than one subtype of EPTB, not limited to the specific subtypes listed in this figure. Other EPTB means that patients did not have the specific subtypes of EPTB listed in this figure).
Figure 6 Drug resistance comparisons between different subtypes of extrapulmonary tuberculosis. (1) STR resistance; (2) INH resistance; (3) RFP resistance; (4) EMB resistance; (5) MDR; (6) Total DR; (7) mono-DR; (8) poly-DR (*with a line means that the drug resistance rates between two groups were significantly different by one-by-one comparison [Bonferroni test]. * and ** after the subtitles means the resistance differences were statistically significant between/among groups, *means P < 0.05, **means P < 0.01. TB, tuberculosis; EPTB, extrapulmonary tuberculosis; STR, streptomycin; INH, isoniazid; RFP, rifampicin; EMB, ethambutol; MDR, multidrug resistance; total DR, total drug resistance, and it means that the isolates were resistant to any of RFP, INH, EMB, and/or STR. Multiple EPTB means that patients have more than one subtype of EPTB, not limited to the specific subtypes listed in this figure. Other EPTB means that patients did not have the specific subtypes of EPTB listed in this figure).CC BY · PubMed Central

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Research works printed but not linked: 4

  1. 2023
  2. 2020
  3. Cao, 2013, The analysis of clinical characteristics on 683 cases with extrapulmonary tuberculosis, Nat Med Front China, 8, 29, 10.3969/j.issn.1673-5552.2013.09.0015 · DOI
  4. 2012 Updated Critical Concentrations for First-Line and Second-Line DST (as of May 2012).

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Metadata

Authors
Yu, Y., Xiang, Y., Liu, H., Yang, S., Li, M., Liu, B., Xu, D., Wu, Y., Li, W., Fang, T., Li, J., Xu, D., Wan, K., Tan, Y., Yuan, X., & Li, G.
Affiliations
  • Central South University (CN)
  • Chinese Center For Disease Control and Prevention (CN)
  • Hunan Province Chest Hospital (CN)
  • University of South China (CN)
Corresponding author
  • Yuan, Xiuqin
  • Li, Guilian
ORCID
Venue
Frontiers in Public Health
Publisher
Frontiers Media SA
Published
2024-07-17
Volume
12
Pages
1405358-1405358
ISSN
2296-2565 (ISSN-L)
DOI
10.3389/fpubh.2024.1405358
PMC
PMC11288871
OpenAlex
W4400746139
Cited by
11
References
23
Citations by year
2026: 8 · 2025: 3
FWCI
3.78
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Chinese Center for Disease Control and Prevention
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, Mycobacterium tuberculosis, drug resistance, multidrug-resistant tuberculosis, rifampicin resistance, tuberculous lymphadenitis, musculoskeletal tuberculosis, urogenital tuberculosis, risk factors, isoniazid resistance, streptomycin resistance, ethambutol resistance, south-central China, Hunan Province
MeSH terms
Tuberculosis, Extrapulmonary, Adolescent, Adult, Antitubercular Agents, Child, China, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Mycobacterium tuberculosis, Retrospective Studies, Rifampin, Risk Factors, Tuberculosis, Multidrug-Resistant, Young Adult

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CoChat. (2026). Citation check: Analysis of epidemiological characteristics of extrapulmonary tuberculosis from South-Central China. https://app.cochat.ai/papers/10.3389/fpubh.2024.1405358
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Yu, Y., Xiang, Y., Liu, H., Yang, S., Li, M., Liu, B., Xu, D., Wu, Y., Li, W., Fang, T., Li, J., Xu, D., Wan, K., Tan, Y., Yuan, X., & Li, G. (2024). Analysis of epidemiological characteristics of extrapulmonary tuberculosis from South-Central China. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2024.1405358