Epidemiology of Extrapulmonary Tuberculosis: A Comparative Analysis with Pre-AIDS Era

doi:10.1378/chest.99.5.1134

Chest

Volume 99, Issue 5, May 1991, Pages 1134-1138

https://doi.org/10.1378/chest.99.5.1134 Get rights and content

To study the changes in the epidemiology of extrapulmonary tuberculosis in Tennessee, we compared the 454 cases of extrapulmonary tuberculosis reported between 1977 and 1981 with 356 cases encountered between 1982 and 1986. The data were analyzed by age, sex, race and site of the disease which were compared with the national statistics during the periods. We observed that 11.3 percent of the total TB cases were extrapulmonary. Unlike national statistics, the proportion of extrapulmonary tuberculosis had remained unchanged between the two study periods. Except for a significant decline (p<0.001) in genitourinary tuberculosis, the incidence of other extrapulmonary TB had remained the same. The higher incidences of lymphatic, miliary, and meningeal TB were noted in nonwhites, particularly in the younger population, during both study periods. While the national trend showed a steady increase in the percentage of extrapulmonary TB cases, there was no change in Tennessee. The reason for a continued decline of CU TB remains unclear. Although AIDS may have contributed toward the increase nationally, fewer cases of AIDS in the state have not influenced the proportion of extrapulmonary TB. Awareness of such regional differences in the epidemiology of TB, and the impact of HIV infection, will be very useful to physicians and other health care providers involved in the diagnosis, treatment, and prevention of tuberculosis. (Chest 1991; 99:1134-38)

Section snippets

METHOD

The case records of 3,159 reported cases of tuberculosis from 1982 to 1986 to the Tennessee Department of Health and Environment were reviewed. Of those, 356 (11.3 percent) cases were extrapulmonary TB.

The TDHE divided the state into eight rural and four metro regions. These four metro regions (Memphis, Nashville, Knoxville, Chattanooga), each with a population exceeding 100,000, have an incidence of TB higher than the rest of the state and contributed up to 41 percent of the total case load.

Incidence of Extrapulmonary TB

The incidence of extrapulmonary TB in the United States as reported to the CDC from 1977 to 1986 is shown in Table 1. During the period, the United States data showed an increase in the proportions of extrapulmonary TB from 14.6 percent in the first five years (1977 to 1981) to 16.6 percent in the next five years (1982 to 1986), which was statistically significant (p<0.0001). In the state of Tennessee, 11.3 percent of the total TB cases were extrapulmonary for the period, which remained

DISCUSSION

In spite of the availability of effective antituberculosis therapy and preventive therapy in the United States for more than three decades, tuberculosis still remains a health care issue in this country. In 1988, there were 21,211 new and active tuberculosis cases in the United States, while it is estimated there were more than 15 million cases of active tuberculosis in the world during the same period. In the international arena, tuberculosis is the leading cause of morbidity and mortality.

The

ACKNOWLEDGMENT

The authors wish to thank Ms. Pam Cameron and the TB Control Program of the Tennessee Department of Health and Environment, Nashville, Tennessee, for their assistance in the preparation of this manuscript.

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: Manuscript received July 10; revision accepted October 01.

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Chest

Clinical InvestigationsEpidemiology of Extrapulmonary Tuberculosis: A Comparative Analysis with Pre-AIDS Era

Section snippets

METHOD

Incidence of Extrapulmonary TB

DISCUSSION

ACKNOWLEDGMENT

Am J Med

Clin Chest Med

Extrapulmonary tuberculosis in Oklahoma, 1965 to 1973

Am Rev Respir Dis

Extrapulmonary tuberculosis in the United States

Am J Epidemiol

Clinical Investigations
Epidemiology of Extrapulmonary Tuberculosis: A Comparative Analysis with Pre-AIDS Era