Clinical spectrum of extrapulmonary tuberculosis at a tertiary care centre in Ghana: a retrospective study

Extrapulmonary tuberculosis (EPTB) presents with diverse clinical manifestations and remains a diagnostic and public health challenge, particularly in high tuberculosis (TB) burden settings such as Ghana. Understanding its clinical spectrum and associated factors is essential for improved case detection and management. This study aims to describe the epidemiology, clinical spectrum, and associated demographic and clinical factors of EPTB in Ghana.

We conducted a retrospective review of TB cases seen at the Chest Clinic of Komfo Anokye Teaching Hospital in Ghana between October 2023 and November 2025. Patients were categorised into pulmonary tuberculosis (PTB) and EPTB. The primary outcome was the clinical manifestation of EPTB, categorised by anatomical site of involvement. Multivariate logistic regression was used to identify factors associated with specific EPTB manifestations, and covariates included age categories, sex, and HIV status. Adjusted odds ratios (aORs) were reported, and statistical significance was set at p < 0.05.

Among 1,098 patients with TB, 179 (16.3%) had isolated EPTB. Patients with EPTB were less frequently male (52.0% vs. 68.8%; p < 0.001) and had lower HIV prevalence (9.0% vs. 14.9%; p = 0.035). Spinal TB was the predominant EPTB manifestation (73, 40.8%), followed by TB lymphadenitis (52, 29.1%), abdominal TB (34, 19.0%), TB pericarditis (13, 7.3%), and central nervous system (CNS) TB (7, 3.9%). Within the EPTB cohort, individuals aged 35–54 years had higher odds of spinal TB (aOR 3.2, 95% CI: 1.5–6.6, p = 0.002). Male sex (aOR 2.8, 95% CI: 1.4–5.7, p = 0.005) and HIV infection (aOR 4.1, 95% CI: 1.3–12.7, p = 0.014) were independently associated with TB lymphadenitis. No significant demographic or HIV-related associations were identified for abdominal TB or TB pericarditis.

Isolated EPTB accounted for approximately one-sixth of all TB cases. Spinal TB and TB lymphadenitis were the predominant manifestations. Distinct demographic and HIV-related associations across EPTB phenotypes underscore the clinical heterogeneity of EPTB and highlight the need for studies evaluating concurrent PTB and EPTB disease to better define the full spectrum of TB in Ghana.