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Clinical Infection & Immunity

Original Article

Volume 1, Number 2, December 2016, pages 41-44

Clinicopathological Study of Tuberculosis Patients in a Tertiary Care Medical College Hospital

Tuberculosis (TB) is one of the leading causes of mortality and morbidity among infectious diseases worldwide and has an enormous economic impact on many countries [1]. Bangladesh is one of the highest TB burden countries, accounting for one-fifth of the global incidence of TB [2]. The disease is more prevalent in the productive age group of 15 - 54 years which causes an economic burden on the individual’s household when they fall sick. The number of TB patients is increasing at a horrifying speed for several reasons. One is the lack of awareness of the disease, which makes patients neglect their symptoms till it is too late. For many they fear that they will surely die of TB and are therefore unable to accept the fact. Another very important reason for hiding the truth is the social stigma attached to TB. Women are thrown out of families, people lose their jobs and children are thrown out of school because of the irrational belief that TB is fatal and will kill all those who live in proximity to a TB patient. Once removed from the family, these people have a seriously diminished quality of life and die on the streets due to complications of the disease and starvation [3]. Extrapulmonary tuberculosis (EPTB) occurs outside the lungs; in lymph nodes and in any organ system even brain and reproductive organs. The bacteria may spread through lymphatic or hematogenous dissemination. The TB bacteria may remain dormant for years at a particular site before causing the disease and may have a wide variety of clinical manifestations leading to difficulty and delay in its diagnosis [4].

An observational study was conducted over a period of 1 year from September 2015 to August 2016 in the Outpatient Department of Jahurul Islam Medical College Hospital and Department of Pathology, Jahurul Islam Medical College, Kishoregonj, Bangladesh. A total of 112 patients, who came to outpatient department, were interviewed. The inclusion criteria of the study were pulmonary tuberculosis (PTB) and EPTB cases diagnosed on the basis of sputum smear, culture, chest radiograph, and cytological and histopathological examination receiving anti-tubercular drugs therapy. Patients unwilling to participate in the study were excluded from the study. Informed consent was taken for the study. Patient’s informed consent form including information regarding the study was provided to the patients for their understanding about the study and participation. Patient informed consent was written in Bengali language. Primary data from each patient we included in TB patient profile form such as age, gender, educational level, annual income in taka, occupational status and selected social habits like smoking and alcohol.

Out of 112 patients studied, 50 (44.6%) were male and 62 (55.4%) were female. The majority of patients (69, 61.7%) were in the age group of 15 - 34 years (Table 1). Annual family income of 78 (69.6%) patients ranged between 36,000 and 150,000 taka. Out of 112 patients, 43 (38.4%) were illiterate and 36 patients (32.2%) were unemployed. Half of the patients were smoker. Among them, 53.5% had PTB (Table 2). The most common sites involved in EPTB were the lymph nodes (38.2%) followed by the pleura (36.4%). The most common symptoms observed in PTB patients were cough with expectoration (96.5%) followed by weight loss (80.7%), fever (73.7%) and loss of appetite (54.4%), whereas in EPTB patients, majority had weight loss (79.6%), fever (67.3%), and loss of appetite (61.2%). Both PTB and EPTB patients had fever (83.3%) and loss of appetite (66.7%) as major clinical symptom (Table 3).

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Table 1. Age and Gender Distribution of the Study Subjects

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Table 2. Socio-Demography and Other Characteristics of Tuberculosis Patients

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Table 3. Clinical Presentation of Patients With Pulmonary and Extrapulmonary Tuberculosis

PTB is an airborne infectious disease caused by Mycobacterium tuberculosis and is a major cause of morbidity and mortality particularly in developing countries. In this study, a total of 112 diagnosed TB patients undergoing treatment were studied. Of these, 50 (44.6%) were males and 62 (55.4%) were females, which suggests that the number of female patients is more compared to male patients which is similar to a study conducted by Othman et al [5]. This could be because women often face some obstacles such as high female illiteracy, ill health with lower immune status, massive house hold work load and economic dependency that allow them limited access to health care. Of the 112 TB patients evaluated, 69 (61.7%) patients were within the age group of 15 - 34 years. This shows that TB mainly infects the productive age group constituting to a strong economic burden and affects their working potentiality. A large number of study populations were illiterate (43, 38.4%). As level of education is an important factor in knowledge about disease, educational status of the community is one of the key factors for the success or failure of the treatment in TB. In the present study, 41.9% were employed. The educational level and employment status of this study were found consistent with the studies from Brazil conducted by Steffen et al [6]. Only 10 (8.9%) of the patients had annual family income more than 2 lacs taka which shows TB affects middle class and lower class economic population group. Unemployment, lower educational level, unhealthy living environment and overcrowding living condition may be the reason for TB in lower socioeconomic class people. This study shows 56 (50%) of the patients are smoker suggesting smoking is one of the main risk factors for TB. Furthermore, behavioral factors especially cigarette smoking and alcohol use have negative effect on TB treatment. Cigarette smoking is known to damage the lungs and suppress the individual adaptive immune responses affecting patient’s response to TB treatment. In our study, 50.9% patients had PTB, 43.7% patients had EPTB and 5.4% had both. PTB was more common than EPTB. This study also shows that PTB is more common in men (54.4%) than in women (45.6%). The same result was also observed in a study by Noertjojo et al [7]. Recent studies have suggested that the sites of EPTB may vary according to geographic location and population. It is well known that lymph node and pleural involvement in TB are a direct extension of the disease from lung parenchyma [8]. In this study, the most common sites involved in EPTB were the lymph nodes (38.2%) followed by the pleura (36.4%) which is consistent with the study from Nepal conducted by Sreeramareddy et al [9]. The signs and symptoms of PTB are typical and known (cough and sputum), whereas EPTB is difficult to identify not only by the patients but also by the clinicians themselves [10]. In this study, 96.5% of patients of PTB and 40.8% patients of EPTB have cough with expectoration which was also observed in a similar study conducted by Othman et al [5].

Our study concludes that majority of the TB patients are within the economically productive age group ranged between 15 and 34 years. Females are the majority of the patients with EPTB while PTB predominantly occurred in men. The most common sites of involvement were the lymph nodes followed by pleura, spine and genitourinary tract. Based on these results, TB control programme might usefully target young and female populations for early diagnosis to decrease TB morbidity and mortality.

Conflicts of Interest

There are no conflicts of interest among authors.

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