INDEX guidelines for extra-pulmonary tuberculosis: knowledge and practice among clinicians in Bengaluru, Karnataka


  • Uma Shankar Shivalingappa National Tuberculosis Institute, Bengaluru, Karnataka, India
  • Sharath Burugina Nagaraja ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India
  • Sarika Jain Aggarwal National Tuberculosis Institute, Bengaluru, Karnataka, India
  • Joydev Gupta National Tuberculosis Institute, Bengaluru, Karnataka, India
  • Jameel Ahmed National Tuberculosis Institute, Bengaluru, Karnataka, India
  • Vinay Gopalswamy ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India
  • Veena P. N. St. Martha’s Hospital, Bengaluru, Karnataka, India
  • Shravika Reddy St. Joseph University Medical Centre Paterson, New Jersey, USA
  • Somashekar National Tuberculosis Institute, Bengaluru, Karnataka, India
  • Kalaiarasan Ellappan ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India



Awareness, Diagnosis, Extra-pulmonary tuberculosis, Tertiary healthcare facilities


Background: Extra-pulmonary tuberculosis (EPTB) remains a major problem in developing countries, which acquire diagnostic and management challenges. The study was conducted to characterize the diagnosed EPTB cases, and to understand the perspectives of clinicians on diagnosis and challenges in its management.

Methods: A total of 150 EPTB patients' medical records were reviewed at two tertiary hospitals in Bengaluru, Karnataka for the period January 2017 to December 2017. The questionnaire-based interview was conducted among clinicians (n=42) during the study period.

Results: The mean age and weight of EPTB patients (females (77, 51%) and males (73, 49%) were 32.5 (±17.5) years and 44.5 (±16.3) kilograms, respectively. Pleural TB (44, 29%), cervical lymph node TB (LNTB) (32, 21%) and abdominal TB (17, 11%) were the most common sites of EPTB involvement, followed by bones and joints TB (11, 7%), spine TB (10, 7%), hilar/mediastinal TB (9, 6%), tuberculoma (8, 5%), TB meningitis (6, 4%), abdominal LNTB (6, 4%), urinary TB (4, 3%) and others (3, 2%). We found GeneXpert was the basis of EPTB diagnosis in 43.3% of cases followed by acid-fast bacilli (AFB) smear microscopy (20.7%) and culture (12.5%). Of 150 EPTB suspected cases, 73% (110) were started anti-TB treatment (ATT), including 8% (12) having received ATT previously. According to LIKERT scale options, 90% of clinicians agreed GeneXpert as a promising diagnostic tool for diagnosis as compared to other microbiological (79%) and histopathological tests (55%).

Conclusions: The quality of EPTB diagnosis and management practices at these institutions is satisfactory according to the principles laid down in INDEX TB guidelines or the national guidelines.


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How to Cite

Shivalingappa, U. S., Burugina Nagaraja, S., Aggarwal, S. J., Gupta, J., Ahmed, J., Gopalswamy, V., P. N., V., Reddy, S., Somashekar, & Ellappan, K. (2023). INDEX guidelines for extra-pulmonary tuberculosis: knowledge and practice among clinicians in Bengaluru, Karnataka. International Journal Of Community Medicine And Public Health, 10(9), 3231–3237.



Original Research Articles