Pattern and Clinical Profile of Tuberculosis Cases Attending a Tertiary Care Centre in Central Kerala, India

Tuberculosis is an ancient disease caused by a microscopic bacterium that primarily attacks the lungs, though it can travel to other parts of the body. For decades, doctors have known that while the infection often starts in the chest, it can also settle in the lymph nodes, the lining of the heart, or the brain, a form of the illness known as extrapulmonary tuberculosis. In many parts of the world, the pattern of who gets sick and where the infection hides varies significantly. In India, which carries the largest share of the global burden of this disease, understanding these local patterns is crucial. Health officials need to know not just how many people are sick, but whether the infection is appearing in the lungs or elsewhere, and what other health problems these patients are facing. This knowledge helps doctors choose the right tests and treatments, and guides public health programs in their race to eliminate the disease.

In a recent study conducted at a major hospital in central Kerala, India, a team of researchers set out to map the specific landscape of tuberculosis cases in their region. They looked at the medical records of 319 patients who had been diagnosed with the disease between January 2024 and December 2025. The goal was to understand the typical profile of these patients: their ages, their genders, the symptoms they complained of, and the other health conditions they were managing alongside the infection. The researchers also examined how the disease was detected and whether the bacteria showed signs of resistance to common medicines.

The study revealed a striking pattern that differs from the classic image of a lung-focused illness. In this hospital setting, the majority of patients, nearly two-thirds, were suffering from extrapulmonary tuberculosis, where the infection had spread beyond the lungs. Only about one-third of the cases were confined to the chest. When the researchers looked at who was most likely to have this form of the disease, they found that younger adults and women were significantly more likely to present with extrapulmonary tuberculosis compared to older adults and men. While the overall number of male patients was higher, the specific risk of the infection appearing outside the lungs was notably higher for female patients and those under the age of 49.

The patients in the study were not just fighting tuberculosis; many were managing other chronic health issues. More than three in ten patients also had diabetes, and a similar proportion had high blood pressure. These coexisting conditions are important because they can complicate the treatment of tuberculosis and affect how well a patient recovers. The most common symptoms that brought these patients to the hospital were a persistent cough, fever, and unexplained weight loss. However, because the infection was often outside the lungs, some patients presented with different complaints, such as back pain, swelling in specific areas, or issues with the central nervous system.

To confirm the diagnosis, the medical team relied heavily on a modern molecular test called CBNAAT, which acts like a highly sensitive search engine for the bacteria's genetic material. This test was used in more than half of the confirmed cases and was the primary tool for detecting the infection and checking if the bacteria were resistant to rifampicin, a key antibiotic. The study found that only a small fraction of the cases, about three percent, showed resistance to this drug. This suggests that while drug-resistant tuberculosis is a concern, the vast majority of cases in this specific region remain treatable with standard medications.

Despite the availability of effective treatments, the study highlighted a challenge in patient care: a significant number of individuals were lost to follow-up, meaning they stopped attending the hospital or could not be tracked after starting treatment. About fourteen percent of the patients fell into this category. The study also noted that 9.7% of participants expired while on treatment, whereas the remaining 90.3% did not report mortality during the treatment period. The researchers noted that the high rate of extrapulmonary cases and the presence of other chronic diseases like diabetes and hypertension require a more integrated approach to care. They suggest that screening for these other conditions alongside tuberculosis, and ensuring patients stay connected to their treatment teams, could improve outcomes. The findings paint a clear picture for this region: tuberculosis is often an infection that hides outside the lungs, affects women and younger adults disproportionately, and frequently travels with other chronic illnesses, demanding a comprehensive and attentive approach from healthcare providers.