Extrapulmonary tuberculosis--a simple diagnosis? A retrospective study at Dar es Salaam, Tanzania

Data from the national tuberculosis programme show that extrapulmonary tuberculosis is increasing rapidly in Tanzania, most likely caused by the human immunodeficiency virus (HIV) epidemic. Retrospective data from 271 patients admitted to Muhimbili Medical Centre (MMC), Dar es Salaam between January 1, 1987 and December 31, 1988 with the diagnosis of extrapulmonary tuberculosis reveal that in only 18% of the cases a bacteriological or histological confirmation of the diagnosis had been made. This figure is only 3% when the tuberculous lymphadenitis cases are excluded. The most common diagnosis was tuberculous pleuritis (119 cases), followed by tuberculous lymphadenitis (67 cases), tuberculosis of the spine (47 cases), tuberculous pericarditis (16 cases) and others. The mean clinical features are presented. In 79 patients the HIV ELISA test was performed, of which 52% were positive. There is an urgent need for improving the diagnosis of extrapulmonary tuberculosis requiring prospective studies.