ABSTRACT
The number of cases of tuberculosis (TB) in the world was estimated to be 7.9 million (95% confidence interval 6.3–11.1), with 1.8 million (1.4–2.8) deaths per year [1] and rising by at least 1% per annum. Although the majority of cases are respiratory, the proportion of cases with non-respiratory disease is rising in both developed and developing countries but for different reasons. In developed countries, particularly in Europe but also in the United States [2], an increasing proportion of cases of TB are occurring in ethnic minority 168groups that have a much higher incidence of TB and also a higher proportion of non-respiratory disease. In England and Wales, for example, in 2005, only 27% of cases were in the white ethnic group, with 73% of cases from non-white ethnic groups and 67% of all cases being foreign born [3]. In England and Wales in the national survey of 1993, for the most recent reported detailed sites of disease, 32% of previously untreated cases had non-respiratory disease [4]. There were important ethnic differences with more than half of all non-respiratory disease coming from the 3% of the population of south Asian ethnic origin. Only 22% of white cases had non-respiratory disease, compared with 35% of other ethnic groups and 42% of the south Asian cases (Table 11.1) [4]. Even within non-pulmonary sites, there were ethnic differences. In all ethnic groups, lymph node disease was the most common site, with 38%, 47% and 63% of white, south Asian and other ethnic groups, respectively; whereas bone/joint TB was proportionately higher in white (15%) and south Asian (14%) cases than in other ethnic groups (8%). Genitourinary cases were higher in white cases (17%) than in south Asian (3.7%) and other ethnic groups (5.6%) (Table 11.1) [4]. Sites of Disease England and Wales 1993
White
Indian Subcontinent
Other
Total
Number of previously untreated patients
1088
1014
356
2458
Respiratory
Number of patients a
834
612
253
1699
Type of lesions+ (%)
Pulmonary
778 (93)
484 (79)
219 (87)
1481 (87)
Pleural
59 (7.1)
70 (11)
24 (9.5)
153 (9.0)
Intrathoracic lymph nodes
6 (0.7)
52 (8.5)
13 (5.1)
71 (4.2)
Other
11 (1.3)
34 (5.6)
7 (2.8)
52 (3.1)
Non-respiratory
Number of patients a
241
428
125
794
Type of lesions b (%)
Lymph node
91 (38)
201 (47)
79 (63)
371 (47)
Bone and joint
35 (15)
60 (14)
10 (8.0)
105 (13)
Genitourinary tract
41 (17)
16 (3.7)
7 (5.6)
64 (8.1)
Abdomen
16 (6.6)
54 (12.6)
11 (8.8)
81 (10)
Central nervous system
9 (3.7)
19 (4.4)
2 (1.6)
30 (3.8)
Miliary
20 (8.3)
29 (6.8)
8 (6.4)
57 (7.2)
Abscess
8 (3.3)
21 (4.9)
7 (5.6)
36 (4.5)
Other
29 (12)
42 (9.8)
8 (6.4)
79 (9.9)
Site of disease not known
36
27
11
74
Source: Kumar D et al. Thorax 52, 1060–67, 1997.23 white patients, 53 Indian subcontinent patients and 33 of other ethnic origin had respiratory and non-respiratory sites.
Some patients had lesions at more than one site (% are of total respiratory or non-respiratory lesions in each ethnic group).
