Extrapulmonary tuberculosis: experience at Veterans General Hospital-Taipei, 1985 to 1987

From 1985 to 1987, 343 cases of extrapulmonary tuberculosis (TB) were identified, representing about 20% of all the newly diagnosed TB cases at Veterans General Hospital-Taipei. Bacteriological and histopathological examinations were of equal importance in making a diagnosis of extrapulmonary TB. However, 79% of the cases of TB meningitis were diagnosed only by positive cerebrospinal fluid cultures for Mycobacterium tuberculosis. The pleura, lymph nodes, urinary and osteoarticular systems were the most commonly affected locations. Male patients predominated except for TB lymphadenitis. However, female patients with TB are more likely to have non-respiratory TB than are male patients. The peak number of cases by age occurred in the seventh decade of life, and the mean age of male patients was older than that of female patients. Pulmonary lesions suggestive of TB and age over 60 years were the two most common risk factors. Anti-TB chemotherapy alone was enough in many patients. However, more than 50% of the patients with osteoarticular TB, pericardial TB, TB lymphadenitis, and TB enteritis or peritonitis underwent surgical intervention for either diagnosis or treatment. The results of adequate anti-TB chemotherapy or surgical treatment were usually satisfactory. About 32% of the patients were lost to follow-up before completing anti-TB chemotherapy. In this series, 34 deaths occurred, of which 7 were TB-unrelated and 10 occurred before a diagnosis of TB was made or proper therapy initiated. Although TB meningitis was uncommon in this series, it had the highest mortality rate (67%).