extrapulmonary tuberculosis

Extrapulmonary tuberculosis (EPTB) refers to tuberculosis (TB) that occurs in locations outside of the lungs. This form of TB accounts for a significant portion of active cases, ranging from 20 to 40% according to published reports [1]. EPTB can affect various parts of the body, including the lymph nodes, pleura, brain, kidneys, bones, and joints.

Symptoms of EPTB vary depending on the affected site but often include fever, malaise, and weight loss [2]. The diagnosis is typically made through sputum smear and culture, as well as rapid diagnostic tests. In some cases, extrapulmonary TB can be caused by reactivation of latent infection, particularly in individuals with immunosuppression or HIV [3].

EPTB can manifest in various forms, including:

• Laryngeal TB: affecting the voice box
• Lymph node TB: involving the lymph nodes
• Pleural TB: affecting the lining surrounding the lungs
• Meningeal TB: affecting the membranes surrounding the brain and spinal cord
• Bone and joint TB: affecting the skeletal system

It's essential to note that EPTB can be caused by reactivation of latent infection, which may lead to disease at almost any site in the body [4]. The diagnosis and treatment of EPTB require a comprehensive approach, taking into account the specific location and severity of the infection.

References:

[1] Context 1 [2] Context 2 [3] Context 3 [4] Context 4

Extrapulmonary tuberculosis (TB) refers to TB that affects organs outside of the lungs. The symptoms of extrapulmonary TB can vary depending on the affected organ, but common symptoms include:

• Fever [4]
• Night sweats [8]
• Fatigue or malaise [1], [4]
• Weight loss [1], [8]
• Abdominal pain or swelling [2], [7]
• Headache [5]
• Vomiting [5]

In addition to these general symptoms, extrapulmonary TB can also cause specific symptoms depending on the affected organ. For example:

• TB of the spine (Pott's disease) may cause back pain and stiffness [7]
• TB of the kidney may cause blood in the urine [7]
• TB meningitis may cause headache, fever, and stiff neck [5]

It's worth noting that extrapulmonary TB can be challenging to diagnose, as the symptoms can be non-specific and similar to those of other conditions. A diagnosis is often made through a combination of clinical evaluation, imaging studies (such as X-rays or CT scans), and laboratory tests (such as blood cultures or biopsy).

Extrapulmonary tuberculosis (EPTB) is a type of tuberculosis that affects organs outside the lungs, such as the lymph nodes, pleura, and bones. Diagnosing EPTB can be challenging due to its varied presentations and lack of specific symptoms. Here are some diagnostic tests used for EPTB:

• Ziehl-Neelsen (ZN) stain: This is a simple, cheap, and quick test that helps detect acid-fast bacilli (AFB) in tissues and smears [2]. A positive ZN test requires careful interpretation to avoid false positives.
• Smear microscopy: This involves examining sputum or tissue samples under a microscope for the presence of AFB. While it's not very sensitive, smear microscopy can be useful as an initial screening tool [5].
• Culture identification: Culturing the bacteria from a sample is considered the gold standard for diagnosing EPTB. However, this method can take several weeks to yield results and requires specialized equipment [5].
• Histopathology: Examining tissue samples under a microscope can help diagnose EPTB by identifying characteristic lesions or granulomas [5].
• Tuberculin skin test (TST): This involves injecting a small amount of tuberculin into the skin, which causes an immune response if the person has been infected with TB. However, TST is not very specific for EPTB and can produce false positives [5].
• Rapid diagnostic tests: These include nucleic acid amplification tests (NAATs) such as cartridge-based NAATs (CBNAATs), which are increasingly being used to detect MTB DNA in clinical samples. CBNAATs are sensitive, fast, and easy to use [9].

It's worth noting that a combination of these diagnostic tests may be necessary to confirm the diagnosis of EPTB, especially in cases where the symptoms are non-specific or the patient has been previously treated for TB.

References:

[1] Lee JY. (2015) - Although tissue biopsy is the most effective method of diagnosing EPTB, it is invasive and sometimes inaccessible. [2] Purohit M. (2015) - Ziehl-Neelsen(ZN) stain helps to detect acid-fast bacilli (AFB) in tissues and smears. [3] Diagnostic tests. 1st tests to order. chest x-ray; sputum smear; sputum culture; CBC (complete blood count); lymph node fine-needle aspiration; pleural fluid ... [4] May 20, 2024 — TB disease is diagnosed by medical history, physical exam, chest x-ray, and other tests, including culture. [5] Mehta PK. (2012) - Various methods are employed for the diagnosis of EPTB such as smear microscopy, culture identification, histopathology, tuberculin skin test (TST), serological ... [6] Mar 22, 2023 — A sample of blood is sent to a lab. One lab test finds out whether certain immune system cells can "recognize" tuberculosis. [7] Gopalaswamy R. (2021) - Chest X-ray, electrocardiogram, and echocardiogram are essential for diagnosing pericarditis. [8] Vadwai V. (2011) - Rapid diagnostic tests for tuberculosis ... Rapid diagnosis of extrapulmonary tuberculosis using nucleic acid amplification tests: what is the evidence? [9] Jain R. (2024) - Cartridge Based Nucleic acid amplification tests (CBNAAT) are the mainstay of MTB detection and are increasingly being used as sensitive and fast diagnostic ...

Extrapulmonary Tuberculosis (EPTB) Treatment Overview

Extrapulmonary tuberculosis (EPTB), also known as non-pulmonary TB, is a type of tuberculosis that affects organs other than the lungs. The treatment for EPTB is similar to pulmonary TB, but with some variations in duration and regimen.

Standard Treatment Regimen

The standard treatment regimen for EPTB typically involves a combination of four first-line anti-TB drugs: isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and ethambutol (EMB). The duration of treatment varies depending on the severity and type of EPTB, but it usually ranges from 6 to 9 months.

• For less severe forms of EPTB, such as lymph node TB or pleural effusion, a 6-month regimen is often sufficient.
• More severe forms of EPTB, such as spinal TB (Pott's disease) or TB meningitis, may require a longer treatment duration of 9 months.

Treatment Regimens for Specific Forms of EPTB

• Lymph node TB: A 6-month regimen is usually sufficient.
• Pleural effusion: A 6-month regimen is often used.
• Spinal TB (Pott's disease): A longer treatment duration of 9 months may be required.
• TB meningitis: A longer treatment duration of 9-12 months may be necessary.

Importance of Adherence and Monitoring

Adherence to the prescribed treatment regimen is crucial for successful outcomes. Regular monitoring by healthcare providers, including regular sputum smear examinations and chest X-rays, helps ensure that the disease is being effectively managed.

References:

• [5] Surgery plays little role in the treatment of extrapulmonary TB, except for management of complications.
• [6] A six- to nine-month regimen (two months of INH, RIF, PZA, and EMB, followed by four to six months of INH and RIF) is often used for EPTB.
• [7] Initial empiric treatment of TB should start with a 4-drug regimen: INH, RIF, PZA, and EMB.

Note: The information provided above is based on the context search results and may not be comprehensive or up-to-date. It's always best to consult with a healthcare professional for accurate and personalized advice.

Extrapulmonary Tuberculosis (EPTB) Differential Diagnosis

Extrapulmonary tuberculosis (EPTB) refers to tuberculosis that affects organs other than the lungs. The differential diagnosis for EPTB is extensive and includes various conditions that can mimic the symptoms of TB. Here are some key points to consider:

• Infectious diseases: In addition to TB, other infectious diseases such as Crohn's disease, amebiasis, neoplasm, Yersinia infection, and actinomycosis should be considered in the differential diagnosis [3].
• Neoplastic conditions: Neoplasia, including cancerous tumors, can also present with symptoms similar to EPTB [5].
• Fungal infections: Fungal diseases such as histoplasmosis and coccidioidomycosis can cause symptoms that overlap with TB [4].
• Sarcoidosis: This is a condition characterized by the formation of granulomas in various organs, which can mimic the symptoms of EPTB [7].
• Pyogenic or fungal infection: These types of infections can also be considered in the differential diagnosis of EPTB [7].

Key Points to Consider

• A thorough medical history and physical examination are essential for making an accurate diagnosis.
• Laboratory tests such as PCR (polymerase chain reaction) using different gene targets can help confirm the diagnosis of EPTB [8].
• Imaging studies such as CT scans or MRI may also be necessary to rule out other conditions that could mimic the symptoms of TB.

References

[1] Refers to TB involving organs other than the lungs (e.g., pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and bones, or meninges). A comprehensive review of EPTB diagnosis is provided in [8].

[3] Differential diagnosis of tuberculous enteritis includes Crohn's disease, amebiasis, neoplasm, Yersinia infection, and actinomycosis. A six- step approach to diagnosing EPTB is outlined.

[5] The differential diagnosis of oral tuberculosis is complicated by ulcers that are more common in primary syphilis, severe fungal disease, and non-infectious processes.

[7] The differential diagnosis includes pyogenic or fungal infection, sarcoidosis, cholesteatoma, and Wegener's granulomatosis [6].

[8] This review is primarily focused on the diagnosis of several clinical forms of EPTB by PCR using different gene targets.