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首页> 外文期刊>Southern African Journal of Infectious Diseases >Extrapulmonary tuberculosis in the setting of HIV hyperendemicity at a tertiary hospital in Durban, South Africa
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Extrapulmonary tuberculosis in the setting of HIV hyperendemicity at a tertiary hospital in Durban, South Africa

机译：在南非德班的一家三级医院中，肺外结核导致艾滋病毒高流行

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Background: South Africa has the highest burden of tuberculosis/human immunodeficiency virus (TB/HIV) co-infection in the world, with the province of KwaZulu-Natal representing the global epicentre of TB/HIV. While significant progress has been made to improve the diagnosis of pulmonary tuberculosis, the diagnosis of extrapulmonary TB (EPTB) remains a significant challenge in resource-constrained settings.Methods: A retrospective chart review was conducted, and included all adult patients diagnosed with EPTB at a tertiary hospital in Durban, South Africa, between January 1, 2016 and March 31, 2016.Results: There were 188 new cases of TB during the study period, with 80 patients diagnosed with EPTB. The mean age of patients was 34.73 (SD?±?9.44) years. Forty-two (52.5%) patients were female, while 76 (96%) were black. The most common risk factor for EPTB was HIV co-infection (88.8%). The median CD4 cell count was 68 (IQR 32–165) cells/mm~(3). Pleural (36.3%), lymph node (28.7%) and abdominal (27.5%) involvement were the most common sites of disease Weight loss, fever, night sweats and cough were amongst the most common symptoms reported. A microbiologically confirmed diagnosis was made in only 65% of cases. In the majority of cases, more than one diagnostic method was used to confirm the presence of TB in distant organs.Conclusion: Immunosuppression, most commonly by HIV, remains the most significant risk factor for the development of EPTB. Advancements in Xpert MTB/Rif and computed tomography have assisted in increasing the diagnostic armamentarium of EPTB. Despite improved access to antiretroviral therapy over the past years, advanced HIV disease remains a significant challenge to TB control.
机译：背景：南非是世界上结核病/人类免疫缺陷病毒（TB / HIV）合并感染的最高负担，夸祖鲁-纳塔尔省（KwaZulu-Natal）是结核/艾滋病毒的全球中心。尽管在改善肺结核的诊断方面已取得重大进展，但在资源有限的地区，肺外结核（EPTB）的诊断仍然是一项重大挑战。方法：进行回顾性图表审查，纳入了所有诊断为EPTB的成人患者。于2016年1月1日至2016年3月31日期间在南非德班的一家三级医院进行了研究。结果：在研究期间，新发现188例TB病例，其中80例被诊断为EPTB。患者的平均年龄为34.73（SD±±9.44）岁。四十二（52.5％）名患者为女性，而76名（96％）为黑人。 EPTB的最常见危险因素是HIV合并感染（88.8％）。 CD4细胞计数中位数为68（IQR 32–165）细胞/ mm〜（3）。胸膜（36.3％），淋巴结（28.7％）和腹部（27.5％）受累是最常见的疾病。体重减轻，发烧，盗汗和咳嗽是最常见的症状。经微生物学确诊的病例只有65％。在大多数情况下，可以使用一种以上的诊断方法来确认远处器官中是否存在结核病。结论：免疫抑制（通常由HIV引起）仍然是发展EPTB的最重要风险因素。 Xpert MTB / Rif和计算机断层扫描技术的进步有助于增加EPTB的诊断装备。尽管在过去几年中获得了更多的抗逆转录病毒疗法，但晚期艾滋病仍然是结核病控制的重大挑战。

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