Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study.
BACKGROUND
Studies from developed countries have reported on host-related risk factors for extra-pulmonary tuberculosis (EPTB). However, similar studies from high-burden countries like Nepal are lacking. Therefore, we carried out this study to compare demographic, life-style and clinical characteristics between EPTB and PTB patients.


METHODS
A retrospective analysis was carried out on 474 Tuberculosis (TB) patients diagnosed in a tertiary care hospital in western Nepal. Characteristics of demography, life-style and clinical features were obtained from medical case records. Risk factors for being an EPTB patient relative to a PTB patient were identified using logistic regression analysis.


RESULTS
The age distribution of the TB patients had a bimodal distribution. The male to female ratio for PTB was 2.29. EPTB was more common at younger ages (< 25 years) and in females. Common sites for EPTB were lymph nodes (42.6%) and peritoneum and/or intestines (14.8%). By logistic regression analysis, age less than 25 years (OR 2.11 95% CI 1.12-3.68) and female gender (OR 1.69, 95% CI 1.12-2.56) were associated with EPTB. Smoking, use of immunosuppressive drugs/steroids, diabetes and past history of TB were more likely to be associated with PTB.


CONCLUSIONS
Results suggest that younger age and female gender may be independent risk factors for EPTB in a high-burden country like Nepal. TB control programmes may target young and female populations for EPTB case-finding. Further studies are necessary in other high-burden countries to confirm our findings.
Sreeramareddy
Chandrashekhar T
CT
Department of Community Medicine, Manipal Teaching Hospital, Manipal College of Medical Sciences, Pokhara, Nepal. chandrashekharats@yahoo.com
Panduru
Kishore V
KV
Verma
Sharat C
SC
Joshi
Hari S
HS
Bates
Michael N
MN
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003906:Developing Countries; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D014376:Tuberculosis / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*