Extrapulmonary tuberculosis - a diagnostic and therapeutic challenge

Introduction: The incidence of extrapulmonary tuberculosis is still high despite of the decrease in global tuberculosis cases during the last years. Objective: Evaluation of predisposing factors and determination of bacteriological and histopathological confirmation rates for extrapulmonary tuberculosis. Method: We performed a retrospective study of 63 cases of extrapulmonary tuberculosis diagnosed in regional supply area between January 2018 and December 2020. The bacteriological examination included Ziehl-Neelsen staining and Lowenstein-Jensen culture from various pathological specimens. In some cases, we also performed GeneXpert and histopathological examination. Results: Cases were predominantly from rural areas and in middle-aged people. The major risk factors were precarious living conditions, unemployment, smoking and alcohol abuse. In 18 cases, the diagnosis was confirmed by bacteriological and in 17 by histopathological examination. In cases without bacteriological or histopathological confirmation, we corroborated the probability criteria as epidemiological, clinical, and imaging findings. Extrapulmonary tuberculosis manifested as pleural (25), osteoarticular (13), nodal (11), meningeal (7), renal (4), cutaneous (2) and gastrointestinal (1) tuberculosis. Bacteriological confirmation of tuberculous pleurisy was made in 3 cases. Osteoarticular tuberculosis had bacteriological confirmation in 6 cases and histopathological in 4. Tuberculosis meningitis was diagnosed in 5 cases by bacteriological examination. Lymph node and cutaneous tuberculosis were confirmed by histopathological examination. Antituberculotic treatment was well tolerated by patients, but the compliance was low (92%). Discussion: Extrapulmonary tuberculosis is a diagnostic challenge due to the difficulty of bacteriological and histopathological confirmation. Conclusion: Increasing early confirmation and careful monitoring of cases can reduce complications and increase treatment compliance.