1. By Dr Antoine Saade WHO TB consultant and LATA president 24 March 2016- Beirut, Lebanon

2.  Mycobacteria arrive normally to the lungs.  They could stay there and remain dormant (TB infection).  or spread through lymphatic and hematogenous dissemination to any part of the body(Extra pulmonary tuberculosis).  extra pulmonary tuberculosis can occur as single disease and sometimes in addition to the pulmonary localization.  Usually, the EPT represents 20% of the total number of all TB cases.  multiple localizations are defined following their site: lymphatic, pleural, osteo articular, genitourinary, miliary, abdominal, meningitis and other.

3. yearPercentage 200036% 200546% 201041% 201535%

5.  The increasing rate of extra pulmonary cases is not limited to Lebanon. At the regional level (EMR), Syria and Jordan have the same situation. At the global level, USA and many European countries and south Asian eastern countries, have also this aspect.  Risk factors: differ from one region to other 1- In the united states: black women black men foreign birth, non-Hispanic black and HIV-positive persons have a significantly higher risk for extra pulmonary tuberculosis 2-In Netherlands: non-western ethnic 3- In the Caucasian population: despite the reduction in the overall incidence of TB, the proportion of EPTB increased. This increasing could be explained by an increase in life expectancy, the predominance of women in the population and by a decline in BCG vaccinated patients.

6.  In Lebanon, Risk factors are: 1- NTP Lebanon accepts all extra pulmonary TB cases referred by specialists without any reconfirmation by the programme, leading to more registered EPTB cases. 2- Female developed more EPTB than male (60% are female) 3- The young age group is also a related factor 4- TB/ HIV and Non National TB patients had no repercussion on the high prevalence of EPTB in Lebanon

7. Probable causes: The high prevalence of extra pulmonary TB cases in Lebanon could be related to:  Genetic factors?  Drinking non pasteurized milk (mycobacterium bovis)?  MOTT could play a certain role in this localization?  More studies are needed to explain the EPTB prevalence in Lebanon and could be subjects for operational researches

8. And Have a nice afternoon