EXTRA-PULMONARY TUBERCULOSIS - A HIGH-FREQUENCY IN THE ABSENCE OF HIV-INFECTION

SETTING: A tuberculosis centre for the diagnosis, management and contr ol of all tuberculosis in a region in Western Canada with a population of approximately 1.2 million. OBJECTIVE: To measure the proportion of cases of extra-pulmonary tuberculosis in relation to country of birth , age and gender of the subject. DESIGN: A prospective study of all pa tients with tuberculosis diagnosed during a five-year period, 1990-199 4. Information relating to age, country of birth and details relating to their tuberculosis were all gathered and stored on a computerised t uberculosis register. RESULTS: A total of 351 patients with tuberculos is were diagnosed during the five-year period. Extra-pulmonary tubercu losis, defined as disease which, with the exception of miliary tubercu losis, was not associated with lung involvement, was diagnosed in 160 (46%) of the patients. The incidence of extra-pulmonary tuberculosis, especially lymph node disease, tended to be higher in younger patients but was significantly higher in immigrants from Asia in whom the majo rity (61%) presented with extra-pulmonary disease. Less than 2% of the subjects in this study were infected with the human immunodeficiency virus (HIV). CONCLUSION: Extra-pulmonary tuberculosis accounted for ap proximately half of the cases of tuberculosis in a western Canadian tu berculosis centre. This high frequency of extra-pulmonary disease was not attributable to HIV infection.