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Analysis of epidemiological characteristics of extrapulmonary tuberculosis from South-Central China
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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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![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).](/paper-figures/fddfcf2b73e64c159b6b0da2e6802cc4/analysis-of-epidemiological-characteristics-of-extrapulmonary-tuberculosis-from-figure-6.jpg)
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“The results of a meta-analysis showed that EPTB represents almost 15% of TB cases, and approximately 10–35% of cases can be found in the head and neck region, most frequently in lymph nodes (87.9%), the other most common location being the larynx [23,26,27].”
From Head and Neck Tuberculosis: A Rare Diagnosis and the Role of Surgical Biopsy and Histopathological Evaluation in Extrapulmonary Disease (2025) · cites this paper as [27]
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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
- Venue
- Frontiers in Public Health
- Publisher
- Frontiers Media SA
- Published
- 2024-07-17
- Volume
- 12
- Pages
- 1405358-1405358
- ISSN
- 2296-2565 (ISSN-L)
- 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
- gold
- doi.org
- 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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