Clinical Profile and Determinants of Pulmonary and Extrapulmonary Tuberculosis: A Cross Sectional Study

Abstract

Background: Tuberculosis continues to be a major global health problem, particularly in low- and middle-income countries. Both pulmonary and extrapulmonary forms present with diverse clinical manifestations that often complicate diagnosis and management. This study aimed to assess demographic characteristics, clinical features, and risk factors associated with pulmonary and extrapulmonary tuberculosis, and to explore their distribution across disease subtypes.

Methods: This inpatient cross-sectional study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal, from July 2023 to April 2025. A total of 180 newly diagnosed tuberculosis patients were enrolled, excluding drug-resistant cases, co-infections, malignancies, and those already on treatment for more than one month. Demographic details, body mass index, smoking history, and clinical features were recorded using structured forms. Patients were classified as pulmonary or extrapulmonary tuberculosis, with further subtyping of extrapulmonary disease. Data were analyzed using chi-square, with p-values less than 0.05 considered significant.

Results: Males constituted 75 percent of cases, and half of the participants reported smoking. Pulmonary tuberculosis was identified in 119 patients, while 61 had extrapulmonary disease. Pleural involvement was the most frequent extrapulmonary subtype, followed by abdominal, central nervous system, and disseminated forms. Night sweats, malaise, fever, and cough were the most common symptoms overall. Neurological and gastrointestinal features were observed exclusively in extrapulmonary cases. Smoking showed a strong association with pulmonary tuberculosis (p = 0.004), while systemic symptoms such as malaise, confusion, abdominal pain, and night sweats were significantly associated with extrapulmonary disease.

Conclusion: Pulmonary and extrapulmonary tuberculosis demonstrate distinct clinical and demographic patterns. Smoking is an important determinant of pulmonary disease, while extrapulmonary tuberculosis presents systemic and atypical symptoms. Strengthening diagnostic capacity, addressing modifiable risk factors, and enhancing clinician awareness are essential for timely recognition and effective management.