LMC journal Vol. 2.indd 56 Original Article L M Coll J 2013; 1(2): 56-58 Extrapulmonary Tuberculosis: A retrospec ve Study at a ter ary care hospital in Palpa, Nepal Thakur CK,1 Khanal LK,1 Jain SK,2 Lamichhane B1 and Poudel A2 1Department of Microbiology, 2Department of Pathology, Lumbini Medical College and Teaching hospital, Pravas, Tansen, Palpa, Nepal. Corresponding author: Chandan Kumar Thakur. Lecturer, Department of Microbiology, Lumbini Medical College, Tansen, Palpa, Nepal; e-mail: chandanpgi@gmail.com ABSTRACT Background: Extra-pulmonary tuberculosis (EPTB) is a signifi cant global health problem. Related studies to it in diff erent places and diff erent dura ons are indicated by many previous research fi ndings. Findings of this study could be benefi cial for its preven ve and control strategies. Methodology: Retrospec ve analysis of clinical specimens submi ed to Central laboratory of Lumbini Medical College and Teaching Hospital (LMCTH) for extrapulmonary tuberculosis was performed. Total 261 samples submi ed from April 2011 to February 2013 were included for analysis in this study. Results: Total 20.7% (54/261) prevalence of EPTB was reported. Based on sites involved; lymph node 87.03%, pleural eff usion7.40%, peritoneal5.55% were found. Gender- wise equal prevalence was seen among male and females. Age-wise prevalence among pa ents between 21-40 years was reported. Conclusion: Our fi nding indicates great necessity for further large scale study on prevalence of EPTB in this loca on for its preven on and control. Keywords: Extrapulmonary tuberculosis, Nepal, Tuberculosis INTRODUCTION Tuberculosis is the most common fatal infec ous disease in the world.1 It ranks as the second leading cause of death from an infec ous disease worldwide, a er the human immunodefi ciency virus (HIV). Geographically, the burden of TB is highest in Asia and Africa.2 Around 45% of total popula on of Nepal is infected with TB. Fourty thousand new cases arising every year, about half of these are infec ous (sputum smear posi ve TB) and 5000-7000 people die each year from TB. However number of deaths in Nepal has reduced due to Introduc on of Directly Observed Treatment Short Course (DOTS).3 Tuberculosis affects all age groups. It can virtually involve any organ system although pulmonary TB is the most common presenta on of disease. Extrapulmonary Tuberculosis (EPTB) is defi ned as the occurrence of TB in any part of the body other than lungs. ExtraPulmonary TB is increasing all over the world. However, only limited data is available about the situa on of EPTB in developing countries.4,5,6 This study was conducted to assess the frequency of EPTB in various organ systems and to evaluate the role of demographic factors like age groups and gender in its causa on. MATERIALS AND METHODS A retrospec ve study was carried out at the Central laboratory of Lumbini Medical College & Teaching Hospital from April 2011 to February 2013. A total of 261 pa ents a ending hospital over 2 years duration were included in this study. All samples were collected by fine needle aspiration cytology (FNAC) & Paracentesis. It was stained by Wright, Papanicolaou (Pap) and Acid fast Stain and examined microscopically. A er screening 261 specimens, 54 were found to be posi ve for Extrapulmonary tuberculosis. Informa on regarding other parameters like age, sex was retrieved from the records of the Medical department. Demographic variables were compared between TB of the lymph nodes and TB involving loca on other than lymph nodes. Data were analyzed using Sta s cal Package for Social Sciences, version 16 (SPSS). RESULTS Out of total 261 samples examined, 54 (20.7%) revealed presence EPTB (Fig.1). EPTB was found to be equal among males and females (27/54 vs. 27/54) (Table.1). Age wise, EPTB was found to be highest among young age group of 21-40 years (32.0%), whereas the lowest number of EPTB cases was among age groups less than ten years as shown in Table.1. Findings of the study showed that, the EPTB in 47(87.03) case was Lymph node, while it affect Pleural fluid in 4(7.40%), and Peritoneal fl uid 3(5.55%) respec vely (Fig.2). DISCUSSION Despite gradual decline in prevalence of TB globally, many research reports indicate EPTB as a signifi cant health problem par cularly in developing countries. 57 CK Thakur et al Shrestha et. al.2010 have reported declining trend of TB in Nepal during 8 years study from 2001-2008.7 Our result, 20.7% prevalence of EPTB matches with results of above men oned study and which might be related to health knowledge and life style of people living in this loca on. However, this result appears dras cally diff erent (less) than prevalence of EPTB compared to fi nding of study in Pokhara.8 This again could be due to same reason in diff erent places. Extrapulmonary TB can aff ect any body parts and mostly it involves Lymph nodes, peritoneum, pleura, bone etc. Ra o of involvement of these may vary according to various previous studies in Nepal and other countries. Our fi ndings report lymph node TB as most common EPTB (87.03%), followed by pleural eff usion TB(7.40%) and peritonial TB (5.55%). This is similar to fi ndings of previous studies by diff erent authors.5,9-14 This indicates that lymphoid involvement is most common in EPTB cases. Our study showed the equal distribu on of EPTB without gender diff erence in male and female which is contrary to fi nding of sreeramareddy et.al (2008) but similar to sreeramareddy et.al (2010).8,15 Our result correlates with many reports of gender unbiasness of EPTB infec on according to other previous research fi ndings.5 We found that EPTB most commonly prevalent among adults (21-40 years) compared to low and high age groups which is similar to previous fi nding of Piryani et.al(2008) but is contrary to that of Sreeramareddy et al (2010).9,15 As we performed retrospec ve analysis, relevant socio- epidemiological informa on’s could not be included for analysis. However, this fi nding has indicated the need for designing of large scale study on prevalence of EPTB and TB in general in this loca on. Further studies on such topics could be milestone for bringing health revolu on in this western-hilly area of Nepal. REFERENCES 1. Sadoon A. Ibraheem, Yaa'rub I. Salih, Haider Saad. Extra pulmonary tuberculosis among pa ents a ended the consulta on clinic of respiratory diseases in Salahiddin Governorate; an epidemiological study. Tikrit Med J 2011; 17(1): 74-80. 2. WHO report 2012 - Global tuberculosis control. [Online] Available from: URL: [http://www.who.int/tb/publications/ global_report/en/index.htm]. 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