title: National profile and treatment outcomes of patients with extrapulmonary tuberculosis in Bénin.
abstract: BACKGROUND
  In sub-Saharan Africa, there is a dearth of published literature on extrapulmonary tuberculosis (EPTB).
  
  
  OBJECTIVE
  To describe demographic, diagnostic and HIV-status characteristics of patients with EPTB in Bénin, their treatment outcomes, and among those who completed their treatment in the Centre National Hospitalier de Pneumo-Phtisiologie (CNHP-P), the proportion whose bodyweight increased during treatment.
  This was a retrospective cohort study with comparisons made between EPTB and new smear-positive pulmonary tuberculosis (NPTB) patients diagnosed in the country from January to December 2011. There were 383 EPTB patients (9% of all TB cases) with a mean age of 35 years, male/female ratio of 1.3 and important regional variation. There were significantly more females (p = 0.001), children <15 years (p<0.001) and HIV-positive patients (p = 0.005) with EPTB compared with NPTB. Pleural effusion, spinal and lymph node tuberculosis accounted for 66% of all EPTB. Children <15 years represented 16% of cases, with lymph node disease being most common among them (p<0.001). Of 130 EPTB patients registered in CNHP-P, 7% had a confirmed bacteriological/histological diagnosis. There were 331 (86%) patients who successfully completed treatment. More patients with EPTB were lost-to-follow-up compared with NPTB (p<0.001) with all these patients from one region. The best treatment completion rates were in children <15 years (OR:3.5, 95%CI:1.0-14.8) while patients with pleural effusion and ascites had the worst outcomes. Of 72 HIV-coinfected patients, 88% were on antiretroviral therapy (ART). HIV-positive status was associated with poor outcomes while those on ART fared better. In the CNHP-P, more than 80% who completed their treatment showed an increase in bodyweight and this was more evident in HIV-positive compared with HIV-negative patients (p = 0.03).
  
  
  CONCLUSIONS
  Patients with EPTB generally do well in Bénin, although the TB Programme would benefit through more attention to accurate diagnosis and earlier start of ART in HIV-infected patients.
authors.affiliation: National TB Programme, Cotonou, Benin.
authors.forename: Serge
authors.initials: S
authors.lastname: Ade
authors.affiliation: International Union against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: International Union against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Trébucq
authors.affiliation: National TB Programme, Cotonou, Benin.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ade
authors.affiliation: National TB Programme, Cotonou, Benin.
authors.forename: Gildas
authors.initials: G
authors.lastname: Agodokpessi
authors.affiliation: National TB Programme, Cotonou, Benin.
authors.forename: Christine
authors.initials: C
authors.lastname: Adjonou
authors.affiliation: National TB Programme, Cotonou, Benin.
authors.forename: Sophie
authors.initials: S
authors.lastname: Azon
authors.affiliation: National TB Programme, Cotonou, Benin.
authors.forename: Sévérin
authors.initials: S
authors.lastname: Anagonou
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use; D001541:Benin / Q000453:epidemiology; D001835:Body Weight; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
references.citation: Trans R Soc Trop Med Hyg. 2013 Dec;107(12):783-8
references.pmid: 24218414
references.citation: Clin Infect Dis. 2012 Jul;55(1):75-81
references.pmid: 22423123
references.citation: Int J Tuberc Lung Dis. 2001 Mar;5(3):213-5
references.pmid: 11326818
references.citation: Int J Tuberc Lung Dis. 2009 May;13(5):620-5
references.pmid: 19383196
references.citation: Thorax. 2009 Dec;64(12):1090-5
references.pmid: 19850965
references.citation: Enferm Infecc Microbiol Clin. 2011 Aug-Sep;29(7):502-9
references.pmid: 21570159
references.citation: Clin Infect Dis. 2004 Jan 15;38(2):199-205
references.pmid: 14699451
references.citation: Clin Chest Med. 2002 Jun;23(2):351-4
references.pmid: 12092030
references.citation: Lancet. 2006 Apr 8;367(9517):1173-80
references.pmid: 16616560
references.citation: PLoS One. 2011 Apr 08;6(4):e18474
references.pmid: 21494617
references.citation: Eur J Epidemiol. 2006;21(9):715-21
references.pmid: 17072539
references.citation: Rev Mal Respir. 2012 Apr;29(4):566-78
references.pmid: 22542414
references.citation: Euro Surveill. 2013 Mar 21;18(12):
references.pmid: 23557943
references.citation: Trop Doct. 2003 Jan;33(1):7-11
references.pmid: 12568510
references.citation: Int J Tuberc Lung Dis. 2003 Dec;7(12):1178-85
references.pmid: 14677893
references.citation: BMC Public Health. 2011 Mar 08;11:154
references.pmid: 21385458
references.citation: Emerg Infect Dis. 2006 Sep;12(9):1434-6
references.pmid: 17073097
references.citation: Probl Tuberk Bolezn Legk. 2007;(7):12-5
references.pmid: 17718068
references.citation: Ann Thorac Med. 2007 Jul;2(3):118-21
references.pmid: 19727358
references.citation: Clin Microbiol Rev. 2011 Apr;24(2):351-76
references.pmid: 21482729
references.citation: Bull World Health Organ. 1999;77(5):386-91
references.pmid: 10361755
references.citation: Int J Infect Dis. 2009 Nov;13(6):722-9
references.pmid: 19196530
references.citation: Clin Infect Dis. 2009 Nov 1;49(9):1350-7
references.pmid: 19793000
references.citation: Public Health Action. 2013 Mar 21;3(1):38-42
references.pmid: 26392994
references.citation: J Clin Microbiol. 2011 Jul;49(7):2540-5
references.pmid: 21593262
references.citation: Emerg Infect Dis. 2006 Sep;12(9):1375-82
references.pmid: 17073086
references.citation: Expert Rev Anti Infect Ther. 2012 Jun;10(6):631-5
references.pmid: 22734954