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Copyright © 2025 Jiajia Yu et al. Canadian Journal of Infectious Diseases and Medical Microbiology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (the “License”), which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. https://creativecommons.org/licenses/by/4.0/

Abstract

Background: Extrapulmonary tuberculosis (EPTB) is a significant health problem which can lead to severe morbidity and mortality. In clinical practice, EPTB can have a variety of nonspecific clinical manifestations and can be concurrent with other types of EPTB. As information pertaining to concurrent EPTB is scarce, research efforts are needed to find concurrent EPTB types and to explore the association networks and rules of concurrent EPTB.

Materials and Methods: An observational multicenter study was carried out at 21 hospitals from 15 provinces in China from Jan 1, 2011, to Dec 31, 2017. All the adult EPTB inpatients (≥ 15 years) were included. Multivariable logistic regression analysis was used to examine the associations of gender and age group for concurrent EPTB. The association network and rules for concurrent EPTB were analyzed by the Apriori algorithm.

Results: A total of 75,993 adult EPTB inpatients (not including EPTB concurrent with PTB) were included. The ratio of male:female was 1.32. The most common types of EPTB lesions were tuberculous pleurisy (46.47%). In the fully adjusted multivariable logistic regression models, it was found that female EPTB patients (aOR = 1.129, 95% CI: 1.081–1.178) were more likely to have concurrent EPTB. As age increased, the risk of concurrent EPTB decreased (aOR < 1, p value for trend < 0.001). The association network graph showed that almost all the EPTB diseases may be concurrent with other types of EPTB. Ureteric tuberculosis and sacral tuberculosis diseases existed mainly in concurrence with other types of EPTB (about 80%). Tuberculous pleurisy and tuberculous lymphadenitis of the neck could be concurrent with more than 60 other types of EPTB disease. The most common concurrent EPTB types were tuberculous peritonitis concurrent with tuberculous pleurisy (1.64%). Sacral tuberculosis concurrentwith lumbar vertebra tuberculosis had the highest confidence value (68.56%). The strongest association rule was found for vesical tuberculosis concurrent with ureteric tuberculosis (lift = 166.18) and ureteric tuberculosis concurrent with vesical tuberculosis (lift = 166.18).

Conclusion: The present study revealed the occurrence of concurrent EPTB types and analyzed the association network and rules among adult EPTB for the first time in a large sample population. Clinicians should be alert to the incidence of concurrent EPTB and that these patients require administration of customized treatment regimens in order to achieve the best outcomes.

Details

Title
Study on the Association Network of Tuberculosis Lesions in Adult Extrapulmonary Tuberculosis in China: A Large-Scale Multicenter Observational Study
Author
Yu, Jiajia 1 ; Chang, Yunqing 2 ; Chen, Liang 3 ; Liu, Shengsheng 4 ; Li, Liang 5 ; Du, Jian 5   VIAFID ORCID Logo  ; Li, Youcai 5   VIAFID ORCID Logo  ; Chen, Hongyan 6 ; Liu, Jianxiong 7 ; Ma, Jinshan 8   VIAFID ORCID Logo  ; Li, Mingwu 9 ; Qin, Jingmin 10 ; Shu, Wei 5 ; Zong, Peilan 11 ; Zhang, Yi 12 ; Yan, Xiaofeng 13 ; Yang, Zhiyi 14 ; Dong, Yongkang 15   VIAFID ORCID Logo  ; Zaoxian Mei 16 ; Deng, Qunyi 17 ; Wang, Pu 18 ; Han, Wenge 19 ; Wu, Meiying 20 ; Chen, Ling 21 ; Zhao, Xinguo 22 ; Tan, Lei 23 ; Li, Fujian 24 ; Zheng, Chao 25 ; Liu, Hongwei 6 ; Li, Xinjie 7 ; Ertai, A 8 ; Du, Yingrong 9 ; Liu, Fenglin 10 ; Cui, Wenyu 12 ; Yang, Song 13 ; Chen, Xiaohong 14 ; Wang, Quanhong 15 ; Han, Junfeng 16 ; Xie, Qingyao 17 ; Feng, Yanmei 18 ; Liu, Wenyu 19 ; Tang, Peijun 20   VIAFID ORCID Logo  ; Zhang, Jianyong 21   VIAFID ORCID Logo  ; Zheng, Jian 22 ; Chen, Dawei 24 ; Yao, Xiangyang 25 ; Ren, Tong 6 ; Yang, Li 7 ; Li, Yuanyuan 8 ; Wu, Lei 9 ; Song, Qiang 10 ; Zhang, Jian 12 ; Yang, Mei 15 ; Liu, Yuanyuan 16 ; Guo, Shuliang 18 ; Yan, Kun 19 ; Shen, Xinghua 20 ; Lei, Dan 21 ; Zhang, Yangli 24 ; Tang, Shenjie 5   VIAFID ORCID Logo  ; Kang, Wanli 5   VIAFID ORCID Logo 

 Department of Infectious Diseases and Clinical Microbiology Beijing Chao-Yang Hospital Capital Medical University Beijing China; Beijing Chest Hospital Capital Medical University Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing China 
 Department of Infectious Diseases Shanxi Bethune Hospital Shanxi Academy of Medical Sciences Tongji Shanxi Hospital Third Hospital of Shanxi Medical University Taiyuan Shanxi Province, China 
 Department of Infectious Diseases Beijing Tsinghua Changgung Hospital School of Clinical Medicine Tsinghua University Beijing China 
 Department of Tuberculosis Anhui Chest Hospital/Anhui Provincial Institute for Tuberculosis Prevention and Treatment Hefei China 
 Beijing Chest Hospital Capital Medical University Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing China 
 Shenyang Chest Hospital No. 11 Beihai Street, Dadong District, Shenyang China 
 Guangzhou Chest Hospital No. 62, Heng Zhi Gang Road, Yuexiu District, Guangzhou Guangdong, China 
 Chest Hospital of Xinjiang No. 106 Yan’An Road, Tianshan District, Urumqi Xinjiang, China 
 The Third People’s Hospital of Kunming No. 319 Wujing Road, Kunming City Yunnan Province, China 
10  Shandong Provincial Chest Hospital No. 12 Lieshishandong Road, Licheng District, Jinan Shandong, China 
11  Jiangxi Chest (Third People) Hospital No. 346 Dieshan Road, Donghu District, Nanchang City Jiangxi Province, China 
12  Chang Chun Infectious Diseases Hospital No. 2699, Sandao Section, Changji South Line, Erdao District, Changchun City Jilin Province, China 
13  Chongqing Public Health Medical Center No. 109, Baoyu Road, Geleshan Town, Shapingba District, Chongqing China 
14  Fuzhou Pulmonary Hospital of Fujian No. 2, Lakeside, Cangshan District, Fuzhou China 
15  Taiyuan Fourth People’s Hospital Number 231, Xikuang Street, WanBailin District, Taiyuan City Shanxi Province, China 
16  Tianjin Haihe Hospital Number 890, Shuanggang Zhen Jingu Road, Jinnan District, Tianjin China 
17  Third People’s Hospital of Shenzhen 29 Bulan Road, District Longgang, Shenzhen China 
18  The First Affiliated Hospital of Chongqing Medical University No. 1 Youyi Road, Yuzhong District, Chongqing China 
19  Weifang No.2 People’s Hospital No. 7th Yuanxiao Street Kuiwen District, Weifang China 
20  The Fifth People’s Hospital of Suzhou No. 10 Guangqian Road, Suzhou City Jiangsu Province, China 
21  Affiliated Hospital of Zunyi Medical College No. 149 Delian Road, Zunyi Guizhou, China 
22  The Fifth People’s Hospital of Wuxi No.1215, GuangRui Road, Wuxi China 
23  TB Hospital of Siping City No. 10 Dongshan Road, Tiedong District, Siping City Jilin Province, China 
24  Baoding Hospital for Infectious Disease No. 608 Dongfeng East Road, Lianchi District, Baoding City Hebei Province, China 
25  The First Affiliated of XiaMen University Zhenhai Roud, Siming District, Xiamen City Fujian Province, China 
Editor
Mahmoud Elhaig
Publication year
2025
Publication date
2025
Publisher
John Wiley & Sons, Inc.
ISSN
17129532
e-ISSN
19181493
Source type
Scholarly Journal
Language of publication
English; French
ProQuest document ID
3207508951
Copyright
Copyright © 2025 Jiajia Yu et al. Canadian Journal of Infectious Diseases and Medical Microbiology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (the “License”), which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. https://creativecommons.org/licenses/by/4.0/