EXTRAPULMONARY TUBERCULOSIS IN WESTERN FR ANCE - RETROSPECTIVE ANALYSIS OF 217 CASES IN THE GERICCO STUDY (1991-1993)

OBJECTIVES: To analyze the epidemiological, clinical and diagnostic ch aracteristics of extrapulmonary tuberculosis in western France observe d from 1991 to 1993 in different patient populations (HIV+ infected pa tients, immunosuppressed non-HIV infected patients, non-immunosuppress ed patients) and according to various localizations (lymph nodes, bone and joints, genital organs, nervous system and meninges, miliary dise ase). METHODS: This retrospective study included 217 cases of extrapul monary tuberculosis diagnosed from 1991 to 1993 in western France by G ERICCO (Groupe d'Epidemiologie et de Recherche en Infectiologie Cliniq ue du Centre-Ouest). Demographic, clinical, biological, microbiologica l and radiographic characteristics as well as clinical course on speci fic therapy were assessed. RESULTS: Extrapulmonary tuberculosis genera lly occurred most often in immunosuppressed patients but 34% of cases were observed in people without any underlying disease or risk factors . Delay to diagnosis was especially long in the non-immunosuppressed p atients (mean = 96 days) but shorter in the HIV-infected patients (mea n = 59 days). It was shorter in case of nervous system involvement (me an = 52 days) or miliary disease (mean = 80 days) than in bone and joi nts (mean = 120 days) and lymph nodes (mean = 102 days). Microbiologic ally proven tuberculosis represented only 75% of cases despite numerou s investigations. Overall prognosis was good except in nervous system and meninges localizations. Failures were mainly due to death in immun osuppressed patients. CONCLUSION: Extrapulmonary tuberculosis remains frequent even in patients lacking risk factors. In 50% of cases, confi rmation of diagnosis takes more than one month, in case of doubt, clin icians should not wait for laboratory results before implementing empi rical specific therapy. (C) 1998, Masson, Paris.