Original articleExtrapulmonary tuberculosis in the northeastern suburbs of Paris: 141 cases
Introduction
A resurgence of tuberculosis was observed in Europe and in the United States in the 1990s [1]. Human immunodeficiency virus (HIV) infection is a significant risk factor but not the only one for tuberculosis. Poor living conditions with homelessness, unemployment, and inadequate access to health care, or being a migrant from a country with a high level of endemic tuberculosis, are all important factors that can explain the high incidence of tuberculosis in big cities and their suburbs. In France, the incidence of tuberculosis decreased between 1970 (58/100 000 inhabitants) and 1989 (16/100 000) [2]. This downward trend persisted until 1991 in certain areas, while in others, notably the Ile de France region, where the incidence of unemployment, migrant status, and homelessness is greater than in other regions of France, figures rose from 1990 onwards [3], with the incidence increasing from 33 per 100 000 inhabitants in 1990 to 38 in 1992, and then decreasing slightly to 37.7 in 1994 [4]. In 1994, 42.8% of the disease notifications came from the Ile de France, which represents only 19% of the French population. The Seine Saint Denis area of the Ile de France was the most severely affected region in 1994, with an incidence of 58.2 per 100 000 inhabitants [3].
These facts led us to report our experience of extrapulmonary tuberculosis in patients not infected by HIV in the Ile de France over a 5-year period.
Section snippets
Patients and methods
This retrospective study was conducted between 1 January 1990 and 31 December 1994 in four departments of internal medicine in Seine Saint Denis and in two departments in the Val d’Oise areas around Paris. All patients with extrapulmonary tuberculosis who were over 15 years of age and not infected by HIV were included. The patients were identified from microbiology laboratory records, pathology records, and discharge diagnoses from each department and hospital.
Results (Tables 1–4)
Because this study was retrospective, HIV serology was not available in 33 patients. These patients had no obvious risk factors for HIV infection and presented no manifestations associated with HIV infection during treatment. A total of 141 patients were studied during this period, and 182 extrapulmonary sites were detected. Over the same period and in the same departments, 45 patients with extrapulmonary tuberculosis who were also infected with HIV were detected. The 25–44 year age group was
Discussion
This study is a reminder of the importance of tuberculosis, especially in big cities and their suburbs, independently of HIV infection. In the case of the Ile de France area, 9–23% [5] of cases of tuberculosis were detected in HIV-infected patients. Extrapulmonary tuberculosis accounts for 15–30% of all cases of tuberculosis in the literature [6]. In the Seine Saint Denis area, the increase in the number of cases of tuberculosis between 1984 and 1994 was mainly due to the increase in
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