Epidemiological, clinical and outcomes of pleural tuberculosis: insights from a 646-patient cohort in the province of Khémisset, Morocco.

INTRODUCTION

pleural tuberculosis, the second most common extrapulmonary manifestation after lymph node involvement, poses a considerable diagnostic and therapeutic challenge. This study examines the epidemiological, clinical, biological, and therapeutic features of pleural tuberculosis cases in Khémisset, a province in Morocco's Rabat-Sale-Kenitra region, which reports the country's second-highest tuberculosis incidence.

METHODS

this retrospective study examined the medical records of patients diagnosed with pleural tuberculosis at the Khémisset Diagnostic Center for Tuberculosis and Respiratory Diseases between 2016 and 2020. A multivariate logistic regression analysis was performed to identify the determinants associated with treatment failure.

RESULTS

over the five-year study period, 646 cases of pleural tuberculosis were recorded, representing 19.8% and 48.8% of all tuberculosis and extrapulmonary tuberculosis cases in our cohort, respectively. The mean patient age was 42 years (standard deviation 22.2), with a male predominance (59.4%, male-to-female ratio of 1.46). A bimodal age distribution was observed, peaking in young adults (20-44 years, 39.6%) and older individuals (>55 years, 34.6%). Geographically, cases were nearly evenly distributed between urban (49.7%) and rural (50.3%) areas. The majority (95.2%) were new pleural tuberculosis cases, while 4.2% had concurrent extrapulmonary or pulmonary tuberculosis involvement. Notably, HIV screening was performed in only 31.1% of cases, all of which yielded negative results. Treatment outcomes were favourable, with a therapeutic success rate of 84.4% and a mortality rate of 8%. Multivariate logistic regression analysis revealed the presence of an association of clinical forms significantly linked to an increased risk of failure. The adjusted model indicates an OR of 2.45 (95% CI: 1.02 - 5.88; P = 0.045).

CONCLUSION

pleural tuberculosis accounts for 1 in 5 tuberculosis cases locally. Our study reveals that, despite high treatment success rates, a significant proportion of patients with pleural tuberculosis fail treatment, particularly those with mixed symptoms, especially if they have a combination of other forms of tuberculosis, which increases the risk of failure.