Relapses of Urogenital Tract Tuberculosis - European Medical Journal
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Relapses of Urogenital Tract Tuberculosis

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Authors:
*Ekaterina Kulchavenya, Denis Kholtobin,1 Moira Tzitzika,1 Michael Samarinas,2 Charalampos Thomas,3 Konstantinos Giannitsas,4 Anastasios Athanasopoulos4
Disclosure:

The authors have declared no conflicts of interest.

Citation
EMJ Urol. ;9[1]:43-44. Abstract Review No. AR5.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

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BACKGROUND AND AIMS

Tuberculosis (TB) is an infectious disease prone to both a self-healing and chronic or recurrent course.1-3 The purpose of the study was to analyse the incidence of recurrence of urogenital TB (UGTB) and to identify the characteristics of patients with recurrent disease.

MATERIALS AND METHODS

Specially created questionnaires on the spectrum of the incidence of extrapulmonary TB (EPTB) in Siberia were analysed. The histories of 140 outpatients with UGTB were also analysed (TB of the urinary and male reproductive system and female genital TB were excluded), and were observed in the Novosibirsk Regional Tuberculous Dispensary between 2010–2019. Among the whole cohort, cases of relapses were selected and analysed in detail.

RESULTS

In 2019, a total of 563 patients with isolated forms of EPTB were diagnosed in the Siberia. Of the cohort, 81 patients (14.4%) had UGTB; one was infected with HIV and the remaining patients with UGTB were HIV-negative. In the cohort of patients who were immunocompetent with EPTB, the share of UGTB was 22.1%, and among patients infected with HIV it was 0.5%. There were three children with UGTB, and all were immunocompetent.

In 99 patients with EPTB (17.6%), the present disease was a relapse. Among all patients with EPTB, relapses of UGTB were diagnosed in 8 patients (8.1%), and all patients with UGTB were HIV-negative. Thus, there was negative correlation between isolated forms of both newly diagnosed and recurrent UGBT and HIV-infection.

In the Novosibirsk region, in a 10-year period, 140 patients were diagnosed with UGTB. One hundred and twenty-seven patients (90.7%) were newly diagnosed, and 13 patients (9.3%) had relapsed. The average age of patients with recurrent UGTB was 53.7. In young patients (30–50 years) this was 46, and in patients older than 50 years this was 54. Among patients with relapse, men predominated (61.5%). The primary focus of TB was located in the organs of the urogenital system in 53.9% of patients. This fact confirms the theory of reactivation of dormant foci. The average relapse time after successful cure of TB was 9.1 years. Mycobacterium tuberculosis was found in 38.5% of patients in the debut of UGTB; all strains were susceptible to anti-TB drugs. In patients with recurrent UGTB, M. tuberculosis was found in 23.1%, and in one patient drug resistance of pathogen to streptomycin and isoniazid was detected. In general, the kidneys were the most susceptible to relapses: they were involved in 69.2% of cases. In 61.5% of cases, the prostate was affected.

Therapy with anti-TB drugs was effective in 92.3% of the patients with recurrent UGTB. Tolerance was worse than in first episode of TB: in 23.1% of patients, different side effects were registered.

CONCLUSIONS

Of the patients with UGTB, 8.1–9.3% had TB and successfully recovered from it. When UGTB recurred, the kidneys were affected in 69.2% of cases, and in 61.5% of cases, the prostate was involved. The majority of patients (61.5%) with recurrent UGTB were men. Therefore, sex may be considered as a predictor of recurrence for UGTB. HIV infection was negatively correlated with both newly diagnosed and recurrent UGTB. In patients with combined lesion (pulmonary TB, HIV infection, and UGTB), the disease course had a prevalence of caseous form, abscesses, and fistulae.

References
World Health Organization. Global tuberculosis report 2019. 2019. Available at: https://www.who.int/tb/publications/global_report/en/. Last accessed: 10 July 2021. Alsultan A et al. Bacterial factors and relapse after tuberculosis therapy. N Engl J Med. 2019;380(2):197.