title: Extra-pulmonary manifestations in a large metropolitan area with a low incidence of tuberculosis.
abstract: BACKGROUND
  The increases in extra-pulmonary tuberculosis (EPTB) have been largely due to human immunodeficiency virus co-infection. The rates of EPTB have remained constant despite the decline in pulmonary tuberculosis (PTB) cases.
  
  
  OBJECTIVE
  To evaluate covariates associated with EPTB.
  
  
  METHODS
  A 4-year cohort of EPTB patients was compared with PTB cases. Enrollees were assessed for TB risk, medical records were reviewed, and Mycobacterium tuberculosis isolates were fingerprinted.
  
  
  RESULTS
  We identified 538 EPTB cases (28.6%) in a total of 1878 enrollees. The most common sites of infection were lymph nodes (43%) and pleura (23%). EPTB cases included 320 (59%) males, 382 (71%) patients were culture-positive, and 332 (86.9%) patient isolates were fingerprinted. Fewer EPTB than PTB patients belonged to clustered M. tuberculosis strains (58% vs. 65%; P = 0.02). A multivariate model identified an increased risk for EPTB among African Americans (OR = 1.9, P = 0.01), HIV-seropositive (OR = 3.1, P < 0.01), liver cirrhosis (OR = 2.3, P = 0.02), and age <18 years (OR = 2.0, P = 0.04). Patients with concomitant pulmonary and extra-pulmonary infections were more likely to die within 6 months of TB diagnosis (OR = 2.3, P < 0.01).
  
  
  CONCLUSIONS
  African American ethnicity is an independent risk factor for EPTB. Mortality at 6 months is partly due to the dissemination of M. tuberculosis and the severity of the underlying co-morbidity.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: O Y
authors.initials: OY
authors.lastname: Gonzalez
authors.forename: G
authors.initials: G
authors.lastname: Adams
authors.forename: L D
authors.initials: LD
authors.lastname: Teeter
authors.forename: T T
authors.initials: TT
authors.lastname: Bui
authors.forename: J M
authors.initials: JM
authors.lastname: Musser
authors.forename: E A
authors.initials: EA
authors.lastname: Graviss
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D016017:Odds Ratio; D011336:Probability; D018570:Risk Assessment; D012424:Rural Population; D017678:Sex Distribution; D015996:Survival Rate; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014505:Urban Population