Epidemiology, Associated Factors, Rifampicin Resistance, and Cytological Findings of Extrapulmonary Tuberculosis among Presumptive Patients at Mehal Meda General Hospital, Ethiopia: A Retrospective Cross-Sectional Study

Abstract Background Tuberculosis (TB) remains a major global public health challenge, with extrapulmonary tuberculosis (EPTB) accounting for a substantial proportion of cases and posing significant diagnostic and therapeutic difficulties. Caused by Mycobacterium tuberculosis , EPTB may exhibit resistance to first-line anti-TB drugs, particularly rifampicin, contributing to the growing burden of multidrug-resistant tuberculosis (MDR-TB). However, epidemiological data on EPTB, drug resistance patterns, and associated risk factors remain limited in Ethiopia. Objective To determine the epidemiology, associated factors, rifampicin resistance, and cytological findings of EPTB among presumptive patients attending Mehal Meda General Hospital, Ethiopia. Materials and Methods A hospital-based retrospective cross-sectional study was conducted at Mehal Meda General Hospital from August 2021 to June 2022. Data were extracted from TB registration logbooks, laboratory records, and patient medical charts. A total of 500 presumptive EPTB cases were included using consecutive sampling. Socio-demographic and clinical data were collected using a structured checklist. Laboratory data included smear microscopy, GeneXpert MTB/RIF assay, and cytological examination of fine needle aspiration cytology (FNAC) specimens. The GeneXpert MTB/RIF assay was used to detect Mycobacterium tuberculosis complex and rifampicin resistance. Cytological findings were used as supportive evidence for granulomatous inflammation suggestive of TB. Data were entered into EpiData version 4.6 and analyzed using SPSS version 25. Bivariate and multivariable logistic regression analyses were performed, with variables having p-value < 0.05 considered statistically significant. Results Among 500 presumptive EPTB patients, the overall prevalence of EPTB was 13.0% (65/500; 95% CI: 9.4–16.4%). The GeneXpert MTB/RIF assay detected 46 positive cases among 347 tested specimens (13.3%), while cytological examination confirmed 19 positive cases among 153 specimens (12.4%). The prevalence of rifampicin resistance among the 65 EPTB-confirmed cases was 10.8% (7/65), all of which occurred in newly diagnosed patients with no prior anti-TB treatment history. Cerebrospinal fluid was the most frequently submitted specimen (185/500, 37.0%), followed by pleural fluid (110/500, 22.0%) and peritoneal fluid (86/500, 17.2%). The highest positivity rates were observed in synovial fluid (6/26, 23.1%), lymph node aspirates (8/39, 20.8%), and cerebrospinal fluid (23/185, 12.4%). On multivariable logistic regression, significant risk factors for EPTB included age > 65 years (AOR = 4.2, 95% CI: 1.25–12.56, p = 0.01), urban residence (AOR = 4.5, 95% CI: 1.52–25.9, p = 0.08), inability to read and write (AOR = 4.5, 95% CI: 1.23–19.11, p = 0.05), farming occupation (AOR = 6.75, 95% CI: 1.75–24.56, p = 0.04), daily labor occupation (AOR = 5.6, 95% CI: 1.56–27.65, p = 0.006), previous pulmonary TB history (AOR = 4.85, 95% CI: 1.56–25.68), contact with PTB patients (AOR = 3.82, 95% CI: 1.85–39.65, p = 0.05), presence of chronic diseases (AOR = 3.84, 95% CI: 1.33–68.99, p = 0.015), HIV-positive status (AOR = 5.6, 95% CI: 1.65–78.8, p = 0.001), frequent alcohol consumption (AOR = 3.2, 95% CI: 1.44–121.2, p = 0.002), and raw milk consumption (AOR = 2.5, 95% CI: 1.25–42.31, p = 0.025). Conclusion This study demonstrated a considerable burden of EPTB and rifampicin-resistant tuberculosis among patients attending Mehal Meda General Hospital. Strengthening laboratory and pathology services and expanding access to rapid molecular diagnostic techniques are essential for early detection. Enhanced surveillance, prompt treatment, and targeted interventions for high-risk populations are needed to improve tuberculosis control in Ethiopia.