Epidemiology

According to the World Health Organization (WHO), every year an estimated 10 million people develop TB, and there are an estimated 1.5 million TB-related deaths.[4] In 2020, disruption caused by the coronavirus disease 2019 (COVID-19) pandemic resulted in a large global decrease in the number of reported new cases; however, the number of reported cases has increased again, with WHO estimating that in 2022 there were 1.3 million TB-related deaths, including 167,000 TB-related deaths among people with HIV.[5]​ The increase in TB-related deaths between 2019 and 2021 reverses years of decline between 2005 and 2019. In England, 4125 people were reported to have TB in 2020 (an incidence of 7.3 in 100,000 population).[6]

Of the 8331 reported cases of active TB in the US in 2021, 18.8% had EPTB only and 10.6% had both pulmonary and extrapulmonary sites of TB.[7]​ In the 2022 US surveillance report, EPTB included lymphatic (26.1% of EPTB), pleural (22.1%), bone or joint (9.4%), peritoneal (6.3%), meningeal (5.8%), genitourinary (4.2%), laryngeal (1.1%), and 'other' (25.1%).[7]​ Patients born outside the US accounted for 73.8% of the total cases of TB in 2022.[7]​ The TB incidence rate was 0.8 in 100,000 for US-born people, and 13 for non-US-born people.[7]​​

Risk factors for EPTB in the US, in addition to HIV infection, include black ethnicity, female sex, young age, and having cirrhosis.[8][9]

In 2022, 170,365 cases of TB were reported in the WHO European Region and 17.0% of these had EPTB.[10]​​ In England, there were 4425 TB cases in 2021, and 47.3% of these had EPTB.[11]

TB is particularly devastating in areas with a high prevalence of HIV infection, such as sub-Saharan Africa.[12] The Global Burden of Disease Study reports that in 2019, there were 217,000 (153,000-279,000) deaths due to tuberculosis among people with HIV and 1.15 million (1.01 to 1.32) incident cases.[13]

TB lymphadenitis was historically considered a disease of childhood, but it is now commonly seen in the young to middle-aged adult population. An increased prevalence has been noted in Asian and black women from TB-endemic areas.

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