Mortality Predictors during Extrapulmonary Tuberculosis in Adults in the Infectious and Tropical Diseases Departments of Fann National University Hospital and Hôpital Principal de Dakar, Senegal

Abstract

Introduction: Pulmonary tuberculosis remains the priority of national disease control programs, while extra-pulmonary cases are increasingly observed, often at a late stage. Additionally, in sub-Saharan Africa, data on these extra-pulmonary locations are scarce. Methodology: This is a prospective, multicenter, descriptive, and analytical study including patients followed for extra-pulmonary tuberculosis in the Infectious and Tropical Diseases Departments of Fann National University Hospital and Hôpital Principal de Dakar, from March 1, 2019, to February 29, 2020. Data were entered into Epi Info™ version 7.2.2.6, exported to Excel, and processed using R software version 3.4.1. Results: Overall, 189 patients were included. The mean age was 39 ± 16 years with a male predominance at 65.6%, representing a sex ratio of 1.9. Regarding medical history, a previous tuberculosis contact was found in 44 patients (23.3%) and a history of tuberculosis in 15 patients (7.9%). HIV infection was the most representative comorbidity in 34.4% of patients, followed by hypertension (7.9%) and diabetes (3.7%). Lymph node tuberculosis was the most frequent (54%), followed by neurological (26.2%), pleural (18.5%), and peritoneal (13.8%) locations in patients living with HIV, while in HIV-negative patients, pleural, peritoneal, and vertebral locations were more frequent than neurological involvement. The case fatality rate was 10.1%. Factors associated with death were age over 60 years: aOR: 1.07 (95% CI: 1.02–1.11), neurological location of tuberculosis: aOR: 7.05 (95% CI: 1.87–26.59), and anemia with hemoglobin level < 10 g/dl: aOR: 7.87 (95% CI: 1.62–38.1). Conclusion: Tuberculosis remains a public health concern in resource-limited countries. In our series, young adult males were the most affected. Lymph node involvement was the most frequent location, followed by neurological and pleural and peritoneal serous involvement. More than a third of patients were co-infected with HIV, and factors associated with death were age over 60 years, neurological location, and the presence of anemia. Proper management of these factors could improve patient care.