Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a major global public health problem. It affects approximately 25% of the population and is one of the leading causes of death from infectious diseases. Diagnosis is based on clinical evaluations, microbiological tests (direct examination, culture), radiological and tomographic investigations. Management involves long-term combination therapies to achieve microbiological negativity and prevent resistance. In cases of drug resistance or comorbidity, therapy must be adapted. The patient's gender may influence clinical presentation and response to treatment. A retrospective analysis of patients treated between 2021 and 2025 will allow us to evaluate the impact of gender on therapeutic response, improving our understanding of the factors that influence clinical outcomes. Study objective: To evaluate the role of gender in the response to treatment of tuberculosis patients followed at the Infectious Diseases Unit of the Ca' Foncello Hospital in Treviso in the period 2021–2025.TB remains a challenge for public health, despite therapeutic advances and control programs. Biological, social, and cultural factors influence presentation, adherence, and outcome. Gender is a variable of interest, with possible differences between men and women in terms of incidence, symptoms, adherence, and frequency of adverse events. The ultimate goal is to better understand the impact of gender on clinical management. Patients and methods: Retrospective, observational, single-center study conducted at the Infectious Diseases Unit of Treviso. Adult patients diagnosed with pulmonary or extrapulmonary tuberculosis, confirmed by microbiological isolation, molecular testing, or histology, associated with clinical/radiological signs, managed between January 1, 2021, and June 30, 2025, were included. Demographic data, comorbidities, clinical presentation, laboratory and radiological parameters were collected, together with information on treatment (regimen, duration, modifications) and outcomes (recovery, success, changes in therapy). The analysis compared males and females. Results: Fifty-eight patients were analyzed, 32 males and 26 females. Forty-five patients completed therapy: 23 males (51.1%) and 22 females (48.9%). All successfully completed treatment, preventing the evaluation of significant differences in therapeutic response. However, differences emerged in the duration of therapy and the occurrence of adverse events. The pulmonary form was prevalent (62%), followed by extrapulmonary or mixed forms. The most common symptoms were cough (71%), fever (29%), and weight loss (25%), the latter being more frequent in males with pulmonary TB (p=0.028). With regard to access to care, one-third of patients (33.3%) went to the emergency room, indicating that many arrive at diagnosis through unplanned pathways, despite the services available. Referrals from general practitioners were less frequent, highlighting room for improvement in early detection. Conclusions: Anti-tuberculosis treatment was effective in all patients, so it was not possible to assess differences in efficacy between the sexes. Women experienced adverse events more frequently, while men were more likely to require prolonged therapy. These data suggest that gender may influence adherence, tolerability, and management of TB. Considering gender as a clinical variable could promote a more personalized approach, improving safety and adherence to treatment.
Background:La tubercolosi (TB), causata dal Mycobacterium tuberculosis, è un rilevante problema di salute pubblica globale. Colpisce circa il 25% della popolazione ed è tra le principali cause di mortalità per malattie infettive. La diagnosi si basa su valutazioni cliniche, test microbiologici (esame diretto, coltura), indagini radiologiche e tomografiche. La gestione prevede terapie combinate, di lunga durata, per ottenere la negativizzazione microbiologica e prevenire resistenze. Nei casi di farmaco-resistenza o comorbidità la terapia va adattata. Il genere del paziente potrebbe influenzare presentazione clinica e risposta al trattamento. Un’analisi retrospettiva dei pazienti trattati nel periodo 2021–2025 permette di valutare l’impatto del genere sulla risposta terapeutica, migliorando la comprensione dei fattori che condizionano gli esiti clinici.Scopo dello studio:Valutare il ruolo del genere nella risposta al trattamento dei pazienti con tubercolosi seguiti presso la UOC di Malattie Infettive dell’Ospedale Ca’ Foncello di Treviso nel periodo 2021–2025. La TB resta una sfida per la sanità pubblica, nonostante i progressi terapeutici e i programmi di controllo. Fattori biologici, sociali e culturali influenzano presentazione, aderenza e outcome. Il genere rappresenta una variabile di interesse, con possibili differenze tra uomini e donne per incidenza, sintomatologia, aderenza e frequenza di eventi avversi. L’obiettivo finale è comprendere meglio l’impatto del genere nella gestione clinica.Pazienti e metodi:Studio retrospettivo, osservazionale, monocentrico, condotto presso l’UOC Malattie Infettive di Treviso. Inclusi pazienti adulti con diagnosi di tubercolosi polmonare o extrapolmonare, confermata con isolamento microbiologico, test molecolari o istologia, associati a segni clinici/radiologici, gestiti nel periodo 1 gennaio 2021–30 giugno 2025. Sono stati raccolti dati demografici, comorbidità, presentazione clinica, parametri laboratoristici e radiologici, insieme alle informazioni sul trattamento (regime, durata, modifiche) e sugli esiti (guarigione, successo, cambi di terapia). L’analisi ha confrontato maschi e femmine.Risultati:Sono stati analizzati 58 pazienti, 32 maschi e 26 femmine. Hanno concluso la terapia 45 pazienti: 23 maschi (51,1%) e 22 femmine (48,9%). Tutti hanno completato il trattamento con successo, impedendo di valutare differenze significative nella risposta terapeutica. Sono emerse, però, differenze nella durata della terapia e nella comparsa di eventi avversi.La forma polmonare è risultata prevalente (62%), seguita da forme extrapolmonari o miste. I sintomi più comuni erano tosse (71%), febbre (29%) e calo ponderale (25%), quest’ultimo più frequente nei maschi con TB polmonare (p=0,028). Per quanto riguarda l’accesso alle cure, un terzo dei pazienti (33,3%) si è rivolto al Pronto Soccorso, indicando che molti arrivano alla diagnosi tramite percorsi non programmati, nonostante i servizi disponibili. Gli invii da parte della medicina generale risultano meno frequenti, evidenziando margini di miglioramento nell’intercettazione precoce.Conclusioni:Il trattamento antitubercolare è stato efficace in tutti i pazienti, per cui non è stato possibile valutare differenze di efficacia tra i sessi. Le donne hanno manifestato più frequentemente eventi avversi, mentre negli uomini è stata più comune la necessità di prolungare la terapia. Questi dati suggeriscono che il genere possa influenzare aderenza, tollerabilità e gestione della TB. Considerare il genere come variabile clinica potrebbe favorire un approccio più personalizzato, migliorando sicurezza e aderenza al trattamento.
Influenza del genere sulla risposta al trattamento nei pazienti con tubercolosi: analisi retrospettiva monocentrica del periodo 2021-2025
SKËNDERI, DESAR
2024/2025
Abstract
Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a major global public health problem. It affects approximately 25% of the population and is one of the leading causes of death from infectious diseases. Diagnosis is based on clinical evaluations, microbiological tests (direct examination, culture), radiological and tomographic investigations. Management involves long-term combination therapies to achieve microbiological negativity and prevent resistance. In cases of drug resistance or comorbidity, therapy must be adapted. The patient's gender may influence clinical presentation and response to treatment. A retrospective analysis of patients treated between 2021 and 2025 will allow us to evaluate the impact of gender on therapeutic response, improving our understanding of the factors that influence clinical outcomes. Study objective: To evaluate the role of gender in the response to treatment of tuberculosis patients followed at the Infectious Diseases Unit of the Ca' Foncello Hospital in Treviso in the period 2021–2025.TB remains a challenge for public health, despite therapeutic advances and control programs. Biological, social, and cultural factors influence presentation, adherence, and outcome. Gender is a variable of interest, with possible differences between men and women in terms of incidence, symptoms, adherence, and frequency of adverse events. The ultimate goal is to better understand the impact of gender on clinical management. Patients and methods: Retrospective, observational, single-center study conducted at the Infectious Diseases Unit of Treviso. Adult patients diagnosed with pulmonary or extrapulmonary tuberculosis, confirmed by microbiological isolation, molecular testing, or histology, associated with clinical/radiological signs, managed between January 1, 2021, and June 30, 2025, were included. Demographic data, comorbidities, clinical presentation, laboratory and radiological parameters were collected, together with information on treatment (regimen, duration, modifications) and outcomes (recovery, success, changes in therapy). The analysis compared males and females. Results: Fifty-eight patients were analyzed, 32 males and 26 females. Forty-five patients completed therapy: 23 males (51.1%) and 22 females (48.9%). All successfully completed treatment, preventing the evaluation of significant differences in therapeutic response. However, differences emerged in the duration of therapy and the occurrence of adverse events. The pulmonary form was prevalent (62%), followed by extrapulmonary or mixed forms. The most common symptoms were cough (71%), fever (29%), and weight loss (25%), the latter being more frequent in males with pulmonary TB (p=0.028). With regard to access to care, one-third of patients (33.3%) went to the emergency room, indicating that many arrive at diagnosis through unplanned pathways, despite the services available. Referrals from general practitioners were less frequent, highlighting room for improvement in early detection. Conclusions: Anti-tuberculosis treatment was effective in all patients, so it was not possible to assess differences in efficacy between the sexes. Women experienced adverse events more frequently, while men were more likely to require prolonged therapy. These data suggest that gender may influence adherence, tolerability, and management of TB. Considering gender as a clinical variable could promote a more personalized approach, improving safety and adherence to treatment.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/93311