Assessment of extra pulmonary tuberculosis (EPTB) cases from selected tuberculosis units (TUs) of Himachal Pradesh, India


  • Ashok Kumar Bhardwaj Professor & Head, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh
  • Dinesh Kumar Assistant Professor, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh.
  • Sunil Kumar Raina Associate Professor, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh
  • Sushant Sharma Lecturer of Bio-statistics, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh
  • Vishav Chander Assistant Professor, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh.





Burden, Extra-Pulmonary Tuberculosis, Tuberculosis Unit.


Introduction: Extra-Pulmonary Tuberculosis (EPTB) gained attention for study its local disease epidemiology for disease control.

Objective: To study the distribution and determinants of EPTB in randomly selected tuberculosis units (TUs) of Himachal Pradesh. Methodology: Multistage random sampling was used; four districts were selected randomly from total 12 districts of state and then one TU was selected from each selected district. In addition, two medical colleges were also included as a referral point for EPTB cases.  

Results: Total 463 EPTB cases were studied during one-year study period; pleural (41.9%) and Lymph Node (31.3%) was frequently observed involved sites. Among male's pleural effusion (48.2%) was commonly involved site followed by lymph node (23.5%), whereas, lymph node was involved in 40.6% followed by pleural effusion in 34.4% females. Other common sites for EPTB were abdomen (6.0%), bone (5.6%), meninges (5.2%) and pericardium (3.9%) and for both males and females. Mean duration of diagnosis since appearance of symptoms was 40 days; only 10.0% of patients received antibiotics for the average of two weeks before formulating EPTB diagnosis. About 35.0% patients underwent FNAC (Fine Needle Aspiration Cytology) to establish diagnosis.

Conclusion: Invasive diagnostic facilities at peripheral health institutions will help further to better understand EPTB epidemiology.


[1] Report. Geneva: WHO; World Health Organization. Global tuberculosis control 2010. Available at: Accessed June 28 2014.

[2] Arora VK, Gowrinath K, Rao RS (1995) Extrapulmonary involvement in HIV with special reference to tuberculosis cases. Ind J Tub 42, 27.

[3] Arora VK, Gupra R (2006) Trends of extrapulmonary tuberculosis under revised national tuberculosis control programme: A study from south Delhi. Indian J Tuberc 53, 77.

[4] Bhardwaj AK, Kashyap S, Bansal P, Kumar D, Raina SK, Chander V, Sharma S. (2014) Factors Influencing Early Health Facility Contact and Low Default Rate among New Sputum Smear Positive Tuberculosis Patients, India. Pulmonary Medicine

[5] Cruz AT, Starke JR (2010) Pediatric tuberculosis. Pediatr Rev 31(1), 13-25.

[6] Chandir S, Hussain H, Salahuddin N, Amir M, Ali F, et al (2010) Extrapulmonary tuberculosis: a retrospective review of 194 cases at a tertiary care hospital in Karachi, Pakistan. J Pak Med Assoc 60, 105.

[7] El-Hazmi MM, Al-Otaibi FE (2012) Predictors of pulmonary involvement in patients with extra-pulmonary tuberculosis. J Family Community Med 19, 88-92.

[8] Fiske CT, Griffn MR, Erin H, Warkentin J, Lisa K, Arbogast PG, Sterling TR (2010) Black race, sex, and extrapulmonary tuberculosis risk: an observational study. BMC Infect Dis 10, 16.

[9] García-Rodríguez JF, Ãlvarez-Díaz H, Lorenzo-García MV, Mariño-Callejo A, Fernández-Rial Ã, Sesma-Sánchez P (2011) Extrapulmonary tuberculosis: epidemiology and risk factors. Enferm Infecc Microbiol Clin 29(7), 502-9.

[10] Gupta SN, Gupta N (2011) Evaluation of revised national tuberculosis control program, district Kangra, Himachal Pradesh, India, 2007. Lung India 28, 163-8.

[11] Ilgazli A, Boyaci H, Basyigit I, Yildiz F (2004) Extra–pulmonary tuberculosis; clinical and epidemiological spectrum of 636 cases. Arch Med Res 35, 435-41.

[12] Jamil B, Qamruddin S, Sarwari AR, Hasan R (2008) an assessment of mantoux tests in the diagnosis of tuberculosis in a BCG-vaccinated, tuberculosis endemic area. Journal of Infectious Diseases 17(1), 18-22.

[13] Kruijshaar ME, Abubakar I (2009) Increase in extrapulmonary tuberculosis in England and Wales 1999-2006. Thorax 64, 1090-5.

[14] Leeds IL, Magee MJ, Kurbatova EV, del Rio C, Blumberg HM, Leonard MK, Kraft CS (2012) Site of extrapulmonary tuberculosis is associated with HIV infection. Clin Infect Dis 55, 75-81.

[15] Makaju R, Mohammad A, Thakur NK (2010) Scenario of Extrapulmonary tuberculosis in Tertiary care center. J Nepal Health research council 16, 48-50.

[16] Malek M, El Hazmi, Fawzia E Al Otaibi (2012) Predictors of Pulmonary involvement in patients with extrapulmonary Tuberculosis. J Family Community Medicine 19, 88-92.

[17] Parimon T, Spitters CE, Muangaman N, Evathrongchit J, et al (2008) Unexpected pulmonary involvement in extrapulmonary TB patients. Chest 134, 589-94.

[18] Prakasha SR, Suresh G, D'sa IP, Shetty SS, Kumar SG (2013) Mapping the pattern and trends of extrapulmonary tuberculosis. J Glob Infect Dis 5(2), 54-9.

[19] Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR (2009) Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin Infect Dis 49(9), 1350-7.

[20] Piryani RM, Kohli SC, Shrestha G, Rawat T (2008) Tuberculosis diagnosed / managed at NGMC, Teaching Hospital, Kohalpur: A joint private-public effort. Kathmandu Univ Med J (KUMJ) 6(21), 28-32.

[21] Pitchenik AE, Cole C, Russell BW, et al (1984) Tuberculosis, atypical mycobacteriosis and acquired immunodeficiency syndrome among Haitian and non-Haitian patients in south Florida. Ann Intern Med 101, 641-5.

[22] Sandgren A, Hollo V, van der Werf MJ (2013) Extrapulmonary tuberculosis in the European Union and European Economic Area, 2002 to 2011. Euro Surveill 18(12), 1-9.

[23] Sharma SK, Mohan A (2004) Extrapulmonary tuberculosis. Indian J Med Res 120(4), 316-53.

[24] Sharma SK, Mohan A, Kadhiravan T (2005) HIV-TB co-infection; epidemiology, diagnosis and management. Indian J Med Res 550-67.

[25] Shanmuganathan A, Srinivasan R, Thilgavathy G, Satishkumar D, Sidduraj C, James B (2013) Determination of Sites Involved, HIV Co-Infection & Utility of Diagnostic Modalities in EPTB. J Clin Diagn Res 1644-46.

[26] Sreeramareddy TC, Panduru VK, Verma SC, Joshi HS, Bates MN (2008) Comparison of pulmonary and extrapulmonary tuberculosis in Nepal – a hospital based retrospective study. BMC Infect Dis 8.

[27] Stelianides S, Belmatoug N, Fantin B (1997) Manifestations and diagnosis of extrapulmonary tuberculosis. Rev Mal Respir 14L, S72-87.

[28] Sudre P, Hirschel BJ, Gatell JM, et al. (1996) Tuberculosis among European patients with the acquired immune deficiency syndrome. The AIDS in Europe Study Group. Tuber Lung Dis 77, 322-8.

[29] Swaminathan S, Ramachandran R, Baskaran G, Paramasivan CN, Ramanathan U, Venkatesan P, et al (2000) Risk of development of tuberculosis in HIV-infected patients. Int J Tuberc Lung Dis 4, 839-44.

[30] TB India (2013). Annual status report. Central Tuberculosis Division. Directorate General of Health Services, Ministry of Health and Family Welfare. Government of India.

[31] Wares F, Balasubramanian R, Mohan A, Sharma SK (2005). Extrapulmonary Tuberculosis: Management and Control. In: Agarwal SP, Chauhan LS, editors. Tuberculosis control in India. New Delhi: Ministry of Health and Family Welfare 95-114.

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