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Euro Surveill. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011

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  • Euro Surveill. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011

    [Source: Eurosurveillance, full text: (LINK). Abstract, edited.]
    Eurosurveillance, Volume 18, Issue 12, 21 March 2013

    Euroroundups

    Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011


    I Solovic<SUP>1</SUP>, J Jonsson<SUP>2</SUP>, M Korzeniewska- Koseła<SUP>3</SUP>, D I Chiotan<SUP>4</SUP>, A Pace-Asciak<SUP>5</SUP>, E Slump<SUP>6</SUP>, R Rumetshofer<SUP>7</SUP>, I Abubakar<SUP>8</SUP>, S Kos<SUP>9</SUP>, P Svetina-Sorli<SUP>10</SUP>, W Haas<SUP>11</SUP>, T Bauer<SUP>12</SUP>, A Sandgren<SUP>13</SUP>, M J van der Werf ()<SUP>13</SUP>
    1. Catholic University, Ru┼żomberok, Slovakia
    2. Swedish Institute for Infectious Disease Control, Stockholm, Sweden
    3. National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
    4. Romanian National Tuberculosis Programme, Institute of Pneumology Marius Nasta, Bucharest Romania
    5. Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Superintendence of Public Health, Ministry of Health, the Elderly and Community Care, Malta
    6. RIVM- Centre Infectious Disease Control, The Netherlands
    7. Tuberkulosestation Karlshaus, Otto Wagner Spital, Vienna, Austria
    8. Research Department of Infection and Population Health, University College London, United Kingdom
    9. Lung Hospital Janov, Mirosov, Czech Republic
    10. University Clinic Golnik, Register for TB, Slovenia
    11. Robert Koch Institute, Berlin, Germany
    12. German Committee against Tuberculosis (DZK), Berlin Germany
    13. European Centre for Disease Prevention and Control, Stockholm, Sweden
    <HR>
    Citation style for this article: Solovic I, Jonsson J, Korzeniewska- Koseła M, Chiotan DI, Pace-Asciak A, Slump E, Rumetshofer R, Abubakar I, Kos S, Svetina-Sorli P, Haas W, Bauer T, Sandgren A, van der Werf MJ. Challenges in diagnosing extrapulmonary tuberculosis in the European Union, 2011. Euro Surveill. 2013;18(12):pii=20432. Available online: http://www.eurosurveillance.org/View...rticleId=20432
    Date of submission: 08 November 2011
    <HR>In the European Union (EU) 72,334 tuberculosis (TB) cases were notified in 2011, of which 16,116 (22%) had extrapulmonary tuberculosis (EPTB). The percentage of TB cases with EPTB ranged from 4% to 48% in the reporting countries. This difference might be explained by differences in risk factors for EPTB or challenges in diagnosis. To assess the practices in diagnosis of EPTB we asked European Union/European Economic Area (EU/EEA) countries to participate in a report describing the diagnostic procedures and challenges in diagnosing EPTB. Eleven EU Member States participated and reports showed that in the majority EPTB is diagnosed by a pulmonologist, sometimes in collaboration with the doctor who is specialised in the organ where the symptoms presented. In most countries a medical history and examination is followed by invasive procedures, puncture or biopsy, to collect material for confirmation of the disease (by culture/histology/cytology). Some countries also use the tuberculin skin test or an interferon-gamma-release-assay. A wide variety of radiological tests may be used. Countries that reported challenges in the diagnosis of EPTB reported that EPTB is often not considered because it is a rare disease and most medical professionals will not have experience in diagnosing EPTB. The fact that EPTB can present with a variety of symptoms that may mimic symptoms of other pathologies does pose a further challenge in diagnosis. In addition, obtaining an appropriate sample for confirmation of EPTB was frequently mentioned as a challenge. In summary, diagnosis of EPTB poses challenges due to the diversity of symptoms with which EPTB may present, the low level of suspicion of clinicians, and due to the difficulty in obtaining an adequate sample for confirmation.
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