National profile and treatment outcomes of patients with extrapulmonary tuberculosis in Bénin

PLoS One. 2014 Apr 22;9(4):e95603. doi: 10.1371/journal.pone.0095603. eCollection 2014.

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.

Material and findings: 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).

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active
  • Antitubercular Agents / therapeutic use
  • Benin / epidemiology
  • Body Weight
  • Coinfection
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Seropositivity
  • Humans
  • Male
  • Middle Aged
  • National Health Programs
  • Retrospective Studies
  • Treatment Outcome
  • Tuberculosis / diagnosis
  • Tuberculosis / drug therapy*
  • Tuberculosis / epidemiology*
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / epidemiology
  • Young Adult

Substances

  • Antitubercular Agents

Grants and funding

The International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, financially supports Serge Ade through a Union Operational Research Fellowship. Funding was from an anonymous donor and the Department for International Development, UK. Additional financial support for this study was provided by the «Service de la santé publique, Lausanne de l’Etat de Vaud, Switzerland. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.