title: A high prevalence of culture-positive extrapulmonary tuberculosis in a large Dutch teaching hospital.
abstract: BACKGROUND
  In the Netherlands the incidence of tuberculosis (TB) has increased during the last decade. Growing immigration and international travel were important determining factors. To determine if this has resulted in altered clinical manifestations of the disease, we assessed the clinical spectrum of all TB cases diagnosed at our hospital in the period 1994 to 2000.
  
  
  METHODS
  All culture-proven TB cases during the study period were retrospectively reviewed for clinical and demographic data.
  
  
  RESULTS
  Sixty-five patients were identified. Solitary pulmonary TB was diagnosed in 33.9%, extrapulmonary TB in 51.8% and combined pulmonary and extrapulmonary TB in 14.3% of all cases. Patients were of foreign descent in 78.6% of all cases. Incidence peaked between 15 to 45 years. Decreased immunity was an important determining factor in the older patients. Presenting symptoms were mostly aspecific causing an important doctor's delay in establishing the diagnosis in 25%. Mortality was 3.6% and isoniazid resistance 3.6%
  
  
  CONCLUSIONS
  Our data suggest an increase in the percentage of extrapulmonary TB concomitantly with an increasing percentage of patients of foreign descent. Because of aspecific presenting symptoms, TB was often diagnosed late. Treatment is mainly hindered by non-compliance and a high index of suspicion is necessary in making the diagnosis.
authors.affiliation: Department of Internal Medicine, Medical Centre Rijnmond-Zuid, Clara, Olympiaweg 350, 3078 HT Rotterdam, the Netherlands.
authors.forename: D A
authors.initials: DA
authors.lastname: Hesselink
authors.forename: S M
authors.initials: SM
authors.lastname: Yoo
authors.forename: G T
authors.initials: GT
authors.lastname: Verhoeven
authors.forename: J W
authors.initials: JW
authors.lastname: Brouwers
authors.forename: F J
authors.initials: FJ
authors.lastname: Smit
authors.forename: J L C M
authors.initials: JL
authors.lastname: van Saase
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents