Pulmonary and Extra Pulmonary Tuberculosis in Qatar: A First Retrospective Population-Based Study

Mohammed Abu Khattab¹, Fahmi Yousef Khan², Mona Al Maslamani¹, Abdul Latif Al-Khal¹, Akram El Gendy², Hussam Al Soub¹, Faraj S. Howady¹

¹Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar.
²Department of Medicine, Hamad General Hospital, Doha, Qatar.

DOI: 10.4236/aid.2015.54018                

Abstract

Background: There is limited information about extra pulmonary tuberculosis (EPTB) in Qatar. The aim of this study is to describe the demographic characteristics of patients with Tuberculosis (TB) in Qatar, and to compare the characteristics of EPTB with those of Pulmonary Tuberculosis (PTB). Patients and Methods: The study was conducted at Hamad Medical Corporation (HMC) in Qatar, from January 2005 to December 2008. It involves all cases of TB diagnosed in Qatar which do not include patients who are diagnosed by routine screening tests upon entry to state of Qatar. Results: 1221 cases of TB were reported; 654 (53.6%) were EPTB; and 567 (46.4%) were PTB. Nine hundred fifty-one (77.9%) were males and two hundred and seventy (22.1%) were females; the mean age was 32.7 ± 811.7 years; only 6.9% (84/1221) of them were Qataris. The most frequent associated condition was diabetesmellitus (DM) (30; 2.5%), and the most frequent site involved was lymph node (285 cases; 43.5%). One thousand two hundred patients continued on first-line drugs while 21 patients received second line treatment. The mean duration of antituberculous therapy was 6.7 ± 1.7 months. Hepatitis was the main drug toxicity. Eight hundred and forty seven patients (69.3%) cured and eight patients (0.7%) died, whereas the remaining three hundred and sixty-six patients (30.0%) had left the country before completing therapy. The proportion of EPTB among females was higher than males, whereas diabetes mellitus was strongly associated with PTB. Conclusion: TB is still common in Qatar with predominance of EPTB. Although male predominated, the proportion of TB, EPTB among females was higher than males.

Keywords

Pulmonary Tuberculosis, Extra Pulmonary Tuberculosis, Tuberculosis in Qatar

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	(2015) Global Tuberculosis Report. World Health Organization. http://www.who.int/tb/publications/global_report/gtbr2015_executive_summary.pdf?ua=1
[2]	WHO (2014) Tuberculosis Country Profiles. https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT %2FTBCountryProfile&ISO2=QA&LAN=EN&outtype=html
[3]	Al Marri, M., Al Hail, L., Al Otaibi, S. and Al Marri, N.D. (2006) The Time of Reactivation of Tuberculosis in Expatriates in the State of Qatar. Qatar Medical Journal, 15, 21-23.
[4]	Sreeramareddy, C.T., Panduru, K.V., Verma, S.C., Joshi, H.S. and Bates, M.N. (2008) Comparison of Pulmonary and Extra Pulmonary Tuberculosis in Nepal—A Hospital-Based Retrospectivestudy. BMC Infectious Diseases, 8, 8. http://dx.doi.org/10.1186/1471-2334-8-8
[5]	Llgazli, A., Boyaci, H., Basyigit, L. and Yildiz, F. (2004) Extrapulmonary Tuberculosis: Clinical and Epidemiologic Spectrum of 636 Cases. Archives of Medical Research, 35, 435-441. http://dx.doi.org/10.1016/j.arcmed.2004.05.008
[6]	Peto, H.M., Pratt, R.H., Harrington, T.A., LoBue, P.A. and Armstrong, L. (2009) Epidemiology of Extrapulmonary Tuberculosis in the United States, 1993-2006. Clinical Infectious Diseases, 49, 1350-1357. http://dx.doi.org/10.1086/605559
[7]	Wang, X., Yang, Z., Fu, Y., Zhang, G., Wang, X., Zhang, Y. and Wang, X. (2014) Insight to the Epidemiology and Risk Factors of Extrapulmonary Tuberculosis in Tianjin, China during 2006-2011. PLoS ONE, 9, e112213. http://dx.doi.org/10.1371/journal.pone.0112213
[8]	Al-Otaibi, F. and El Hazmi, M.M. (2010) Extra-Pulmonary Tuberculosis in Saudi Arabia. Indian Journal of Pathology & Microbiology, 53, 227-231. http://dx.doi.org/10.4103/0377-4929.64327
[9]	Ullah, S., Shah, S.H., Aziz-ur-Rehman, Kamal, A., Begum, N. and Khan, G. (2008) Extrapulmonary Tuberculosis in Lady Reading Hospital Peshawar, NWFP, Pakistan: Survey of Biopsyresults. Journal of Ayub Medical College Abbottabad, 20, 43-46.
[10]	Karim, M.M., Chowdhury, S.A., Hussein, M.M. and Faiz, M.A. (2006) A Clinical Study on Extrapulmonary Tuberculosis. Journal of Bangladesh College of Physicians and Surgeons, 24, 19-28.
[11]	Fader, T., Parks, J., Khan, N.U., Manning, R., Stokes, S. and Nasir, N.A. (2010) Extrapulmonary Tuberculosis in Kabul, Afghanistan: A Hospital-Based Retrospective Review. International Journal of Infectious Diseases, 14, e102-e110. http://dx.doi.org/10.1016/j.ijid.2009.03.023
[12]	Arstaedt, A.S. (2013) Extrapulmonary Tuberculosis among Adults: Experience at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. South African Medical Journal, 104, 22-24. http://dx.doi.org/10.7196/samj.6374
[13]	Gomes, T., Reis-Santos, B., Bertolde, A., Johnson, J.L., Riley, L.W. and Maciel, E.L. (2014) Epidemiology of Extrapulmonary Tuberculosis in Brazil: A Hierarchical Model. BMC Infectious Diseases, 14, 9. http://dx.doi.org/10.1186/1471-2334-14-9
[14]	Noertjojo, K., Tam, C.M., Chan, S.L. and Chan-Yeung, M.M.W. (2002) Extra-Pulmonary and Pulmonary Tuberculosis in Hong Kong. International Journal of Tuberculosis and Lung Disease, 6, 879-886.
[15]	Rowińska-Zakrzewska, E., Korzeniewska-Kosela, M. and Roszkowski-Sliz, K. (2013) Extrapulmonary Tuberculosis in Poland in the Years 1974-2010. Pneumonologia i Alergologia Polska, 81, 121-129.
[16]	Gunal, S., Yang, Z., Agarwal, M., Koroglu, M., Arici, Z.K. and Durmaz, R. (2011) Demographic and Microbial characteristics of Extrapulmonary Tuberculosis Cases Diagnosed in Malatya, Turkey, 2001-2007. BMC Public Health, 11, 154. http://dx.doi.org/10.1186/1471-2458-11-154
[17]	Wang, X., Yang, Z., Fu, Y., Zhang, G., Wang, X., Zhang, Y. and Wang, X. (2014) Insight to the Epidemiology and Risk Factors of Extrapulmonary Tuberculosis in Tianjin, China during 2006-2011. PLoS ONE, 9, e112213. http://dx.doi.org/10.1371/journal.pone.0112213
[18]	Ducomble, T., Tolksdorf, K., Karagiannis, I., Hauer, B., Brodhun, B., Haas, W. and Fiebig, L. (2013) The Burden of Extrapulmonary and Meningitis Tuberculosis: An Investigation of National Surveillance Data, Germany, 2002 to 2009. Eurosurveillance, 18, pii: 20436.
[19]	Prakasha, S.R., Suresh, G., D’sa, I.P., Shetty, S.S. and Kumar, S.G. (2013) Mapping the Pattern and Trends of Extrapulmonary Tuberculosis. Journal of Global Infectious Diseases, 5, 54-59. http://dx.doi.org/10.4103/0974-777X.112277
[20]	Ozvaran, M.K., Baran, R., Tor, M., Dilek, I., Demiryontar, D., Arinc, S., Toker, N., Chousein, E.U. and Sogukpinar, O. (2007) Extrapulmonary Tuberculosis in Non-Human Immunodeficiency Virus-Infected Adults in an Endemic Region. Annals of Thoracic Medicine, 2, 118-121. http://dx.doi.org/10.4103/1817-1737.33700
[21]	Musellim, B., Erturan, S., Sonmez Duman, E. and Ongen, G. (2005) Comparison of Extra-Pulmonary and Pulmonary Tuberculosis Cases: Factors Influencing the Site of Reactivation. International Journal of Tuberculosis and Lung Disease, 9, 1220-1223.
[22]	http://www.unaids.org/sites/default/files/country/documents//QAT_narrative_report_2014.pdf