Studying cases of extrapulmonary tuberculosis in the National Center for Tuberculosis Control in Damascus
Authors: Jbawi Ahmad al , Fadel Mohammad , Kahal Fares , Najjar Michel , Albuaini Sara , Mohammad Yser 
Published: March 2022

Abstract
Background :Tuberculosis (TB) is a major public health concern worldwide and is the 13th leading cause of death and the second deadliest infectious disease after COVID-19. ¹ Extrapulmonary tuberculosis (EPTB) cases accounted for 16% of the 7.5 million cases of TB worldwide in 2019. ² global statistics indicate that Tuberculosis kills about 4,500 patient every day¹.Aims :1. To know the epidemiology of extrapulmonary tuberculosis in Syria.2. To know the effect of pulmonary tuberculosis risk factors on extrapulmonary tuberculosis.3. To know the percentage of TB recurrence .4. To know the percentage of non-adherence to tuberculosis treatment.5. The comparison of the incidence of extrapulmonary tuberculosis over an 18-year period.Methods :A retrospective study conducted at the National Center for Tuberculosis Control in Damascus and its countryside for the year of 2020 to analyze the patients with extrapulmonary tuberculosis .Results :205 patients were diagnosed with extrapulmonary tuberculosis in Damascus and its countryside in the year of 2020 and the sites of extrapulmonary tuberculosis were distributed as follows :Lymph Nodes TB (102) 49.75% , peritoneal TB (28) 13.66% , pleural TB (26) 12.68% , spine TB (Pott's disease) (11) 5.36% , meningeal TB (8) 3.90% , skeletal TB (7) 3.41% , skin and soft tissue TB (5) 2.44% , genitourinary TB (5) 2.44% , gastrointestinal tuberculosis (5) 2.44% , pericardial TB (3) 1.46% , eye Tb (3) 1.46% , ENT Tb (1) 0.49% , breast TB (1) 0.49%In diagnosing tuberculosis of the lymph nodes by biopsy the affected nodes were distributed as follows :Cervical lymph nodes 80.40% , Axillary lymph nodes 6.86%. , Supraclavicular lymph nodes 4.90% , Submandibular lymph nodes 2.94% , Mesenteric nodes 2.94% , Mediastinal nodes 1.96%.Most incidence rate was in patients between 25 and 34 years old , while the least incidence rate was in patients older than 65 years old . The percentage of infected females was approximately 66%, while the percentage of infected males was approximately 34% . The majority of infected patients were residents in the city (78.68%) compared to infected patients from the countryside (21.31%). The most common comorbidities among patients with extrapulmonary tuberculosis were:Hypertension: 23.41% of cases , Diabetes Mellitus : 15.12% cases , Chronic obstructive pulmonary disease: 2.4% , Covid-19: 9.75% were diagnosed with COVID-19, 9 of which were confirmed by PCR testing, and 11 cases were diagnosed clinically . 17 of those infected with Covid-19 had lymph nodes tuberculosis, two had urogenital tuberculosis, and one case was with pleural tuberculosis . Possible risk factors were : Smoking: (cigarettes and hookah) 38.53% of extrapulmonary tuberculosis patients were smokers of cigarettes and waterpipes in addition to passive smokers, while 61.46% were non-smokers , Unhealthy housing: 23.41% of patients live in an unventilated or unsunny houses , Forced displacement: 20.97% of all patients which forced them to live in crowded and unhealthy places , cases of relapse: 12 cases of recurrence (5.85%) , cases of non-adherence to tuberculosis treatment: 9 cases (4.39%) , Prisoners : 6 cases (2.92%). The most common general symptom associated with extrapulmonary tuberculosis was fever 55.60%, while night sweats was the least common symptom 14.63% .Conclusion :Tuberculosis is a major public health concern worldwide that can cause death or cause long-lasting complications but still is a preventable and treatable disease that’s why disease prevention , early diagnosis and early treatment are vital.