{'fraction_non_alphanumeric': 0.028296652487516182, 'fraction_numerical': 0.022193452931385242, 'mean_word_length': 4.462626262626262, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
CBNAAT Study of Extra-Pulmonary Tuberculosis among Population of North Andhra Pradesh

Background & Objectives: Extra pulmonary tuberculosis (EPTB) constitutes 15 to 20% of total cases of tuberculosis in India. It is high in incidence among HIV and Pediatric group and involves almost all systems of the body. Cbnaat (Catridge-based nucleic acid amplification test) is of definitive value in its diagnosis. The present study aims at knowing the prevalence of EPTB among the population of Visakhapatnam of North Andhra. Material & Methods: 12,372 cases of EPTB out of total cases (old & new) of 67,017 are studied from the data at District Tuberculous Center, Visakhapatnam for the period 2007 to Aug 2018. Results & Discussion: FNAC samples of lymph nodes and others reported highest (177) among EPTB followed by pleural effusion (28) and pus & abscess (30) showing similar and bronchial wash (26). In the present study EPTB showed overall prevalence of 18.80 similar to Indian average of 15 to 20%. PTB: EPTB is 4: 1 in males and 2 : 1 in females showing more in incidence in the latter. Hence the target group for EPTB is more of female population as they are vulnerable due to anaemia, malnutrition and low immunity. Conclusions: Though the emphasis is more on PTB case finding, EPTB is also significant and has to be paid attention in the control of tuberculosis.


Introduction
Tuberculosis still remains a thorn in our sole despite intense efforts to control it. Even today India has the highest 7 TB burden accounting for 1.9 million cases out of 9.1 million globally. Extra pulmonary tuberculosis (EPTB) involves almost every organ system in the body. Its burden ranges from 15 to 20 % of all TB cases among HIV -Ve patients and about 40 to 50% in HIV +Ve new TB patients. EPTB has significant impact on the people and the economy. Diagnosis is difficult. Latest 6 Gene-Xpert (Cbnaat) has revolutionised the diagnosis of TB particularly EPTB.

Limitations
Factors like HIV status, Diabetes, Anaemia, alcohol, smoking, pollution, slum area problem and co-morbid conditions like COPD, CKD, CANCER etc. are not part of the present study due to the paucity of data. The emphasis is on the highly sensitive Cbnaat diagnostic result of the cases of EPTB.

Material and Methods
The material for the study is obtained with permission from the district tuberculous officer, Visakhapatnam. The method adopted is the tabulation and calculation on the excel sheet at the research center of GIMSR. The bio-statistician is consulted to adopt the relevant statistical methods applied wherever necessary. The health status indicators such as the incidence, prevalence, case fatality rate, the failure and default rate of EPTB cases among the population of Visakhapatnam city and district are considered for the study. The study is done with the permission of the institutional research body on self financing mode as it is performed out of our academic interest on such a vital topic of tuberculosis.

Bio-Statistics
Certain relevant health status 10 indicators like prevalence, incidence, PTB-EPTB ratio, case fatality rate, relapse rate, failure rate and default rate are calculated as per the formulae though the emphasis is made on prevalence of EPTB.    (Table-4). Hence, the EPTB share of total TB cases is similar to Indian average of 15 to 20%. Table -5 shows the PTB : EPTB gender ratio in males is about 4:1 but in females it is 2:1 for the period of study 2015 to 2018. The 5 CBNAAT diagnostic results confine to 2 to 3 years for 2016,2017,2018, as this Gene-Xpert has come into force recently throughout India, yet not spread widely. The present sample study shows EPTB of lymph node (FNAC) maximum in occurrence followed by abscess and pleural taking next. The Rifampcin resistance in the present study population is 4 -5% (Table-6) far less than Indian average ( cases which is 24% in PTB. MDR is more often reported with PTB. Pleural followed by lymph node is the pattern of EPTB in their study and even in the present study FNAC is followed by abscess and pleural equally. Another recent study by Anita Velingker from Goa for the period 2013 to 2015 of 1,598 cases revealed 31% incidence of EPTB cases with 47% among HIV +Ve with diabetes. Here also pleural is followed by lymphatic in the incidence maximum among 30 to 50 years age group.

Conclusions
The prevalence of EPTB maintains a plateau without much fluctuations over years as per the present study. The case burden is more in the society as they are not suspected and not referred to Cbnaat centers. 11 With the establishment of more and more of Gene-Xpert machines network all over the areas, EPTB case load can cross the tip of the iceberg coming to the surface. Provision has to be made in 3 RNTCP in this aspect. There is no separate emphasis on EPTB control by the RNTCP. Hence all the hospitals (both private & govt) have to be directed by the G.O.I. to tackle cases of EPTB in co-ordination with the control agencies. EPTB resulting in surgery has to be done free of cost or at gross concession at all private hospitals. A special provision has to be made through the health insurance scheme. It has to be made compulsory for all private hospitals to purchase Gene-Xpert so that more cases of EPTB can be diagnosed and the drug treatment can be provided by the govt. nodal agencies.

Conflict Of Interest: Nil
Financial Support: Nil