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Tuberculosis
Increase in extrapulmonary tuberculosis in England and Wales 1999–2006
  1. M E Kruijshaar1,
  2. I Abubakar1,2
  1. 1
    Tuberculosis Section, Respiratory and Systemic Infections Department, Centre for Infections, Health Protection Agency, London, UK
  2. 2
    School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
  1. Correspondence to Dr M E Kruijshaar, Tuberculosis Section, Respiratory and Systemic Infections Department, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK; michelle.kruijshaar{at}hpa.org.uk

Abstract

Background: Extrapulmonary tuberculosis appears to be increasing in England and Wales. The trends in extrapulmonary tuberculosis and factors associated with these trends were examined.

Methods: National tuberculosis surveillance data from 1999–2006 for England and Wales were used, including demographic, clinical and laboratory information. Trends in the proportion of tuberculosis cases with extrapulmonary disease were investigated using the χ2 trend test and associated factors using logistic regression.

Results: Among all the cases of tuberculosis, the proportion with extrapulmonary disease increased from 48% in 1999 (2717 cases) to 53% in 2006 (4205 cases, p<0.001). Regression analysis showed that the rise in extrapulmonary disease was associated with an increase in the proportion of non-UK born cases (odds ratio 2.7, 95% CI 2.6 to 2.8). A more than threefold increase was observed in the proportion of all tuberculosis cases with miliary tuberculosis from 0.7% of all cases (38 cases) to 2.2% (180 cases, p<0.001). This rise was not associated with changes in place of birth or in any of the other risk factors identified.

Conclusions: The proportion of cases with extrapulmonary disease has increased over the study period. To a large extent this is due to an increasing proportion of non-UK born cases. Reasons for the rise in miliary tuberculosis require further investigation. Clinicians should have a higher index of clinical suspicion of extrapulmonary tuberculosis in non-UK born cases.

https://doi.org/10.1136/thx.2009.118133

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    Footnotes

    • Funding No external funding was obtained.

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Ethics approval This study was carried out with national surveillance data. The Health Protection Agency has Patient Information Advisory Group approval to hold and analyse national surveillance data for public health purposes under Section 60 of the Health and Social Care Act 2001.

    • The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit the paper for publication.