Comparative analysis of pulmonary and extrapulmonary tuberculosis: A seven-year experience from a refugee host country, Turkiye

Abstract

Objective: To investigate and compare the demographic characteristics, clinical findings, and laboratory results of pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) patients, among Turkish citizens, and foreign nationals.

Methods: This study included patients aged 18 and over, both Turkish citizens and foreign nationals, diagnosed with PTB or EPTB between 2016 and 2022. All patients were divided into PTB and EPTB group, and demographic characteristics, clinical findings, and laboratory results were compared. Patients with both PTB and EPTB were not included in the comparison. Multivariate logistic regression analysis was conducted to identify potential risk factors for PTB.

Results: Among the 261 TB cases included, 46 patients (17.6%) had PTB, and 188 (72%) had EPTB. The percentage of female patients was significantly higher (P=0.003) in EPTB compared to PTB group. While the prevalence of diabetes mellitus (P=0.002), hypertension (P=0.017), coronary obstructive pulmonary disease (P=0.001), congestive heart failure (P=0.005), coronary artery disease (P=0.001) and immunosuppressive medication use (P=0.017) were significantly higher in PTB patients than in EPTB patients. Multivariate logistical analysis reveals that male (OR 2.6, 95% CI 1.3-5.5, P=0.009), diabetes mellitus (OR 2.7, 95% CI 1.2-6.1, P=0.015), and asthma (OR 6.3, 95% CI 1.2-33.9, P=0.032) were associated with an increased risk of PTB. Social security coverage (P<0.001) and regular employment status (P<0.001) were found to be lower and the presence of multidrug resistance (P=0.002), isoniazid resistance (P=0.012), and rifampin resistance (P=0.012) were found to be significantly higher in foreign-national TB patients comparing with Turkiye citizens.

Conclusions: Patients with PTB need to be evaluated for comorbidities and PTB should be investigated in men, in patients with diabetes mellitus or asthma if there are clinical findings suspicious for TB. TB screening for foreign nationals upon entry into the country is essential for TB control and elimination.

Keywords

Pulmonary tuberculosis / Extrapulmonary tuberculosis / Refugees / Immigrants / Comorbidities

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