Abstract
World Health Organization (WHO) defined Extrapulmonary Tuberculosis (EPTB) as TB of organs other than the lungs exactly, such as lymph nodes, kidneys, genitals, breast, liver, skin, bones and joints, and pleura. Accordingly Russian Guidelines pleural TB is a part of pulmonary TB, as pleura actually is a cover of lungs and belongs to respiratory system and thus couldn't be considered as extrapulmonary organ. Different approaches makes estimation of real epidemiology of EPTB impossible.
To confirm this point we estimated a spectrum of EPTB in Novosibirsk including and excluding pleural TB.
Total of 175 patients with EPTB were revealed in Novosibirsk in 2014: 67 had pleural TB and 108 had real EPTB forms. Comparison of WHO and Russians versions of a spectrum of EPTB is done in a table.
Form of EPTB | Number of patients | % by WHO version | % by Russian version |
Pleural TB | 67 | 38.2 | n/a |
TB of bones and joints | 38 | 21.7 | 35.2 |
CNS TB | 29 | 16.5 | 26.8 |
UGTB | 18 | 10.2 | 16.7 |
Lymph nodes TB | 15 | 8.9 | 13.9 |
others | 8 | 4.5 | 7.4 |
CNS TB - TB of central nervous system UGTB - urogenital TB
We see very different incomparable proportion of EPTB forms in dependence on its spectrum. We think pleural TB should be excluded from the spectrum of EPTB. Why isolated pleural TB is EPTB, but if it accompanied widespread destructive forms of pulmonary TB it is not counted at all? A rule of mathematic statistic notes – if one parameter of the system is significantly higher than others, this parameter doesn't belong to the estimated system. For example, the share of TB of CNS among real EPTB is 26.8%, but among EPTB including pleural TB – 16.6% only. What figure is true? For the best comparison we need unique approach, and Russian one is optimal.
- Copyright ©the authors 2016