ORIGINAL RESEARCH article
Front. Cell. Infect. Microbiol.
Sec. Clinical Infectious Diseases
Deciphering the Population Dynamics and Drug-Resistance Characteristics of Extrapulmonary Tuberculosis: Genomic and Clinical Insights from a Chinese Hospital
Provisionally accepted
Xinyue Li1
Shiwei Gong2Youyi Rao2Jun Chen2Yanjie Hu2Jianjian Guo2Kai Wang2Chang Liu2Qian He2
Yanlin Zhao1*Yi Ren2*- 1National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention, No. 155 Chang Bai Road, Changping District, Beijing 102206, China, Beijing, China
- 2Department of Laboratory Medicine, Wuhan Institute for Tuberculosis Control, Wuhan Pulmonary Hospital, Wuhan, 430030, China., Wuhan, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Extrapulmonary tuberculosis (EPTB) is characterized by atypical clinical symptoms, difficult diagnosis, and high mortality, so it is very important to know the prevalence and drug resistance (DR) status. This study analyzed 427 isolates of EPTB from a Chinese hospital. Drug susceptibility testing for widely used anti-TB drugs was performed. All isolates were subjected to whole-genome sequencing (WGS) to explore the molecular characteristics of resistance and to perform phylogenetic analysis. Clinical characteristics and DR patterns associated with Mycobacterium tuberculosis (MTB) lineages were evaluated using chi-square analysis, and associations with DR-EPTB were assessed using multinomial logistic regression. The number of EPTB strains exhibited a general upward trend, and most EPTB cases in this study were accompanied by PTB. The predominant types were tuberculosis of urinary system (29.98%), tuberculous meningitis (23.65%), and lymph node tuberculosis (22.72%). Quadratic regression revealed a decline in urinary system cases and an increase in lymph node cases. Lineage 2 accounted for 83.60% of isolates and was significantly associated with isoniazid (INH) and streptomycin (STR) resistance. Overall resistance rates were 13.58% for INH and 7.73% for rifampicin (RIF). Male sex was associated with higher DR risk (aOR = 1.63, p = 0.046). Common resistance mutations included katG Ser315Thr, rpoB Ser450Leu, and gyrA mutations. The clustering rate was 19.67%, indicating limited recent transmission. The predominance of lineage 2 and high rates of anti-tuberculosis drug resistance indicate that EPTB remains a clinically and epidemiologically significant problem.
Keywords: Extrapulmonary tuberculosis, Mycobacterium tuberculosis, Epidemiology, Drug-resistant TB, whole genome sequencing
Received: 26 Aug 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Li, Gong, Rao, Chen, Hu, Guo, Wang, Liu, He, Zhao and Ren. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yanlin Zhao, zhaoyl@chinacdc.cn
Yi Ren, menease@sina.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.