More than half of tuberculosis cases in Morocco in 2025 were extrapulmonary, a figure well above global levels. Dr. Tayeb Hamdi explains what this form of tuberculosis is and outlines the possible reasons behind its unusually high prevalence. AP ‹ › In 2025, more than half of tuberculosis cases in Morocco were extrapulmonary. The Health Ministry announced on World Tuberculosis Day this Tuesday that the figure reached 53%. The striking proportion is far higher than global levels, according to Dr. Tayeb Hamdi, physician and researcher in health policy and systems. «Globally, extrapulmonary tuberculosis accounts for only 15% to 20% of cases, while 75% to 80% are pulmonary», he told Yabiladi. Tuberculosis is an airborne infection that primarily affects the lungs. «After inhalation, the bacterium typically settles in the lungs, where it may remain dormant for years. In some cases, instead of causing pulmonary disease, it spreads through the bloodstream or lymphatic system to other organs or lymph nodes», he explained, referring to extrapulmonary tuberculosis. «In extrapulmonary tuberculosis, this bacterium can affect virtually any organ, including the brain, heart, kidneys, and bones, but the most common form involves lymph nodes», he added. Different symptoms, lengthy diagnosis The main difference lies in the symptoms. Pulmonary tuberculosis presents with well-known signs such as fever, persistent cough, hemoptysis, weight loss, loss of appetite, and night sweats. «Diagnosis is relatively straightforward, based on chest X-rays and sputum analysis, often confirmed within hours», Hamdi said. Extrapulmonary tuberculosis, on the other hand, is much more difficult to diagnose, he noted. Patients may present with non-specific symptoms such as abdominal pain, back pain, seizures, or cardiac issues. He also pointed out that patients often present with enlarged lymph nodes in the neck or under the arms without knowing the cause, when in fact these are linked to tuberculosis. «This often leads to multiple consultations before a diagnosis is established, making the process longer and more complex and increasing the risk of complications». Possible factors Several hypotheses have been put forward to explain this high rate. «One is the consumption of unpasteurized milk, which can transmit Mycobacterium bovis from cattle to humans, often leading to lymph node tuberculosis», he explained. Other factors may include immune system characteristics and environmental conditions in the Mediterranean region. «It is also possible that certain immune responses facilitate the spread of the tuberculosis bacteria from the lungs to other organs via the bloodstream or lymphatic system», he added. Another explanation could be that «improved diagnostic capacity in Morocco has led to the detection of more cases». However, these factors do not fully explain the unusually high rate. «Further research is needed to understand this high incidence. There is also a need to discourage the consumption of unpasteurized milk and regulate its sale in informal markets», he said. He also stressed the need to raise awareness, noting that many people still believe tuberculosis is only a pulmonary disease, without realizing it can affect other organs. From a prevention standpoint, tuberculosis is closely linked to socioeconomic conditions. The bacterium «thrives in conditions of poverty, overcrowding, and weakened immunity, including among people living with HIV/AIDS», he said. «Prevention therefore involves improving living conditions and ensuring that close contacts of infected individuals follow appropriate preventive measures, including, in some cases, prophylactic treatment», he concluded.
