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Extra pulmonary TB which affects organs other than lungs can be
1) Lymph node TB- painless swelling of lymph nodes mostly in neck area. These lymph nodes can become enlarged and may have drainage from it.
2) Pleural TB- It can present as fluid collection in the pleural cavity. Patient may present with fever, chest pain and shortness of breath. Chest x-ray may show cavity. AFB
(Acid-Fast Bacilli) may be present in the fluid. Needle biopsy of the pleura is definitive diagnosis.
3) Empyema- Collection of pus in the pleural cavity. X-ray may show air fluid levels. Fluid may be positive for
AFB (Acid-Fast Bacilli). Treatment is drainage of the fluid and medications.
4) TB of upper airways- Larynx, pharynx and epiglottis may be affected. May present with difficulty in swallowing, and ulcerations maybe e present in examination of the larynx, Biopsy is required for diagnosis.
5) Genito-urinary TB- occurrence is around 15%. This happens secondary to blood spread. Pain while urinating, blood in the urine and flank pain may be seen. Urine examination and culture lead to 90% diagnosis. IVP measure lesions in the kidney.
6) Bone TB - Bone or Skeletal TB occurs in 10% of cases because of blood spread. Usually bigger joints are affected, such as spine, hips, and knees.
Acute back pain, unexplained weight loss, fever and night sweats are
symptoms synonymous with Spinal Tuberculosis, also known as Pott spine
which accounts for almost 50 percent of musculo-skeletal TB in developing
countries. Spinal lesions can lead to collapse of the vertebrae. Abscesses may form along the sides of the vertebral body. The compression of the spine may lead to weakness or inability to use lower extremities. This is a medical emergency. Drainage of the abscess should be done immediately. Bone TB usually responds to medication but in some cases, surgery may be needed.
7) TB Meningitis-occurs in 5% of cases, usually happens in young children and immunosuppressed (HIV positive) adults. May present as headache, mental change, confusion, weakness, altered mental status, neck stiffness. Diagnosis is by lumbar puncture. AFB staining and culture of the cerebral spinal fluid may be done as well. CT scan and MRI may show hydrocephalus. If unrecognized and untreated, mortality is 100%. There is good response to treatment.
8) GI TB- may present as abdominal pain, diarrhea, blood in the stool, and mass in the abdomen. Fever, weight loss and night sweats may be present. Surgery is needed as treatment.
9) TB pericarditis- Fatality is up to 40%. Diagnosis is by echocardiogram and pericardiocentesis- or removing of fluid from the space around the heart.
10) Miliary TB- caused by blood spread of Tuberculosis bacilli. Usually in children, it presents as primary TB and in adults as reactivation of old TB. It causes small seed-like lesion in different parts of the body. Fever, night sweats, anorexia, weight loss, weakness, and respiratory symptoms may be present.
Diagnosis
There should be high index of suspicion depending on history of exposure.
Chest x-ray may show cavity infiltration.
Skin test may be done. It is called Mantoux test or PPD, where a small amount of tuberculin is injected into the skin. The reading is done in 48-72 hours after placement. A raised nodule is positive. There also can be false positives in skin tests. 1) Those who have been vaccinated with BCG vaccine or 2) Those infected with other Mycobacterium infections.
Cultures- both blood and sputum can be cultured. Microscopy or smear of the sputum may show AFB positive bacilli. Cultures usually take 4-8 weeks to grow.
Nucleic Acid amplification may be done of the sputum and may be done in a few hours.
Treatment
TB is treatable in almost all cases, but if left untreated can be
fatal in 5 years. One- third die in one year, and half in
five years.
First line of drugs used for TB- INH, rifampin, pyrazinamide, ethambutol – for approximately 4-6 months.
Side effects of drugs
Rifamphin- rash, liver toxicity, orange colored urine
INH- fever, chills, hepatitis, peripheral neuritis, seizures
Pyrazinamide- increased uric acid
Ethambutol-optic neuritis
Prevention
BCG vaccination is recommended in newborns in areas where TB is common.
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