What is Extrapulmonary Tuberculosis?

J.M. Willhite

Extrapulmonary tuberculosis (TB) is a bacterial infection that may present anywhere in the body. Associated with exposure to Mycobacterium tuberculosis, extrapulmonary tuberculosis is most frequently diagnosed in individuals with human immunodeficiency virus (HIV). Also known as disseminated tuberculosis, it is generally treated with a combination of antibiotics. Individuals with extrapulmonary tuberculosis may be cured with timely and appropriate treatment.

Antibiotics are the typical course of treatment for a patient suffering with extrapulmonary tuberculosis.
Antibiotics are the typical course of treatment for a patient suffering with extrapulmonary tuberculosis.

A diagnosis of extrapulmonary tuberculosis is generally made with the aid of several diagnostic tests. Depending on the site of infection, individuals may undergo general tests that include a blood panel and urinalysis. Imaging tests may be conducted to check for signs of inflammation, as often occurs in the presence of infection, and evaluate soft tissue and organ condition and functionality. Aspiration may be performed, which involves the use of a needle to obtain a fluid sample, if infection is suspected in one’s joints or membranous tissues, such as the pericardium that protects the heart. It is not uncommon for a spinal tap to be performed if meningeal inflammation is present.

Urinalysis is one test used to diagnose extrapulmonary tuberculosis.
Urinalysis is one test used to diagnose extrapulmonary tuberculosis.

Aside from HIV infection, there are other contributory factors that may increase one’s chance for infection. Those who have knowingly been exposed to the tuberculosis pathogen, but have never received a diagnosis, are considered at greatest risk for developing disseminated TB. Certain chronic conditions, such as diabetes and alcoholism, which can impair one’s immunity, may also place an individual at significant risk for infection and complications.

Since TB is transmitted through the air, the infection will initially pass through the lungs. When one’s immunity is compromised, the body is unable to fight off the contagion, allowing it to potentially metastasize throughout the body. Extrapulmonary TB may present as a localized infection or progressively invasive to several areas of the body. It may settle anywhere in the body, but most commonly affects the bowel, bones, and lymphatic system. It is not uncommon for some individuals with extrapulmonary tuberculosis to remain asymptomatic for quite some time before becoming ill.

The presentation of extrapulmonary TB symptoms is entirely dependent on the location and severity of infection. Individuals will often develop localized discomfort and inflammation that gradually worsens and may be accompanied by fever and malaise. Those whose extrapulmonary tuberculosis affects their urinary, nervous, or digestive systems may be at risk for secondary infection, impaired organ function, and irreversible damage. Complications associated with infection can include abscess formation, coma, and septic shock.

Treatment is generally centered on the aggressive administration of a combination of antibiotics. To prevent infection transmission, re-infection, and complications, it is essential that individuals complete the antibiotic regimen in its entirety and as directed. In some cases, if severe inflammation is present, a corticosteroidal medication may also be given. Completing treatment is essential to a good prognosis.

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