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Home / The International Journal of Tuberculosis and Lung Disease, Volume 26, Number 4

Open Access Concomitant pulmonary disease is common among patients with extrapulmonary TB

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BACKGROUND: Microbiologic screening of extrapulmonary TB (EPTB) patients could inform recommendations for aerosol precautions and close contact prophylaxis. However, this is currently not routinely recommended in India. Therefore, we estimated the proportion of Indian patients with EPTB with microbiologic evidence of pulmonary TB (PTB).

METHODS: We characterized baseline clinical, radiological and sputum microbiologic data of 885 adult and pediatric TB patients in Chennai and Pune, India, between March 2014 and November 2018.

RESULTS: Of 277 patients with EPTB, enhanced screening led to the identification of 124 (45%) with concomitant PTB, including 53 (19%) who reported a cough >2 weeks; 158 (63%) had an abnormal CXR and 51 (19%) had a positive sputum for TB. Of 70 participants with a normal CXR and without any cough, 14 (20%) had a positive sputum for TB. Overall, the incremental yield of enhanced screening of patients with EPTB to identify concomitant PTB disease was 14% (95% CI 12–16).

CONCLUSIONS: A high proportion of patients classified as EPTB in India have concomitant PTB. Our results support the need for improved symptom and CXR screening, and recommends routine sputum TB microbiology screening of all Indian patients with EPTB.

Keywords: Mycobacterium tuberculosis infection; cough; infectious disease transmission; retraining; symptom evaluation

Document Type: Research Article

Affiliations: 1: Johns Hopkins India, Pune, India 2: Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India 3: Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India 4: Johns Hopkins School of Medicine, Baltimore, MD, USA 5: Johns Hopkins India, Pune, India, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins School of Medicine, Baltimore, MD, USA 6: Byramjee Jeejeebhoy Government Medical College, Pune, India 7: District Tuberculosis Office, Thiruvallur, India 8: Johns Hopkins School of Medicine, Baltimore, MD, USA, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 9: World Health Organization, Geneva, Switzerland

Publication date: April 1, 2022

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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