Clinical manifestation the symptoms of extrapulmonary tuberculosis depend on the sites if infection. The stop tb strategy now emphasizes the timely diagnosis and treatment of all cases of tuberculosis, including smearnegative pulmonary and extrapulmonary tuberculosis. Diagnosis is most often by sputum smear and culture and, increasingly, by rapid molecularbased diagnostic tests. Manifestations shift by site yet for the most part incorporate fever, discomfort, and w. Moreover, eptb is viewed as one wastebasket diagnosis, as the other which is not pulmonary. Tuberculosis may infect any part of the body, but most commonly occurs in the lungs known as pulmonary tuberculosis. The two types of clinical manifestation of tuberculosis tb are pulmonary tb ptb and extrapulmonary tb eptb. Extrapulmonary tuberculosis is defined according to who classification criteria as an infection by m. Multivariate logistic regression model determining the independent risk factors for development of extra pulmonary tuberculosis relative to pulmonary tuberculosis. Extrapulmonary tuberculosis peter davies, director tuberculosis research unit liverpool. Sometimes infection directly extends from an adjacent organ. Extra pulmonary tuberculosis peter davies, director tuberculosis research unit liverpool. For example, miliary tb is classified as ptb because there are lesions in the lungs. Discussion our study reports epidemiology and risk factors of eptb from a highburden country where the prevalence of.
Mar 31, 2016 if tb infection is not primarily located in the lungs, it is called extrapulmonary tb extra outside of, pulmonary affecting the lung. Apr 02, 2015 the two types of clinical manifestation of tuberculosis tb are pulmonary tb ptb and extrapulmonary tb eptb. Discussion our study reports epidemiology and risk factors of eptb from a highburden country where the prevalence of hiv is low. Miliary disease is seen in 10 percent of patients who have aids and pulmonary tuberculosis, and in 38 percent of those who have aids and extrapulmonary tuberculosis. Diagnosis of extra pulmonary tuberculosis by culture. Pleural and ganglionar extrapulmonary tuberculosis are the most frequent forms, followed by genitourinary tuberculosis, symptoms of extrapulmonary tuberculosis depend on the affected organ. The symptoms of extra pulmonary tuberculosis are more varied, but fever and weight loss are present in the majority of cases. Infectious droplet nuclei are generated when persons who have pulmonary or laryngeal tb disease.
While much focus has been paid to pulmonary tuberculosis, eptb has received scant attention. Tuberculosisextrapulmonary tuberculosis clinical features. Person being evaluated for extra pulmonary tuberculosis for patients with the following conditions, consultation with the delegating physician is required for patients to be treated under this protocol. Extrapulmonary tuberculosis medical journals of india. Extrapulmonary tuberculosis tb infectious diseases msd. The treatment of tuberculosis in general, is standardized by various. Therapy duration and longterm outcomes in extrapulmonary. Eptb refers to tb involving organs other than the lungs e. Person being evaluated for pulmonary tuberculosis or 4. Extrapulmonary tb eptb results from the hematogenous and lymphatic spread of m.
Chapter 2 transmission and pathogenesis of tuberculosis. Clinical manifestations of pulmonary and extrapulmonary. Extrapulmonary tuberculosis symptoms, diagnosis and. The remaining patients will have latent tb, which can advance to active infection in times of immunosuppression. Clinical forms of extrapulmonary tuberculosis it depends on the affected organ. This is a retrospective cohort study of all patients treated for eptb in the state of texas between january 2000 and december 2005. Epidemiology of extrapulmonary tuberculosis among inpatients. Extrapulmonary involvement occurs in the musculoskeletal system and the most affected area is the spine. Disease of the larynx for example, which is part of the respiratory system, is respiratory but extrapulmonary. The most frequent forms of extrapulmonary tb observed were skeletal tb 41. Definition extrapulmonary tuberculosis eptb refers to disease outside the lungs. Extrapulmonary definition of extrapulmonary by medical. Extrapulmonary tb eptb results from the hematogenous and lymphatic spread of rculosis bacilli. Patients who are infected but who have no clinical, bacteriological, or radiographic evidence of.
Early diagnosis of eptb is crucial for treatment, and atypical presentations of tb should be kept in mind for immunocompetent. Tuberculosis is a dangerous bacterial infection that attacks your lungs. These are collectively denoted as extrapulmonary tuberculosis. While the majority of tb infections affects the lungs, tb can infect any place in the body. Disease of the larynx for example, which is part of the respiratory system, is respiratory but extra pulmonary. It occurs in patients with latent tb, frequently due to immunocompromise e. The best laboratory diagnosis is by bacterial standard reference for diagnostic. Definition extra pulmonary tuberculosis eptb refers to disease outside the lungs.
Treatment duration may need to be extended for central nervous. Tuberculosis tb is one of the worlds most deadly infective diseases. Extrapulmonary tuberculosis is when tuberculosis affects in parts of the body other than the lungs. Updated tb testing and treatment recommendations for health care personnel video world tb day 2020 digital media toolkit. The most frequent forms of extrapulmonary tb observed were. Extrapulmonary tb occurs more commonly in immunosuppressed persons and young children. Extra pulmonary tuberculosis symptoms, signs, causes, risk. Symptoms vary by site but generally include fever, malaise, and weight loss. It is spread by inhaling tiny droplets of saliva from the coughs or sneezes of an infected person. Person being evaluated for extrapulmonary tuberculosis for patients with the following conditions, consultation with the delegating physician is required for patients to be treated under this protocol. Tb meningitis is a medical emergency, and any delay in diagnosistreatment may result in irreversible neurological sequelae. There are many parts of the body which tuberculosis can affect, including the lymph nodes, nervous system as well as. It is sometimes confused with nonrespiratory disease. Extra pulmonary involvement occurs in the musculoskeletal system and the most affected area is the spine.
Those who are immunocompromised are especially at risk, because their immune systems can have trouble fighting the bacterium. Infectious disease clinical tb outside the lungseg, lymph nodes, pleura, brain, kidneys, or bones. People with the germ have a 10 percent lifetime risk of getting sick with tb. Extrapulmonary tuberculosis is tuberculosis tb within another location in the body than the lungs. This occurs in 1520% of active cases, causing other kinds of tb. Although the disease usually responds to standard antitb drug therapy, the duration of treatment has not yet been established because smear. Guidelines for management of tb, drtb and leprosy in ethiopia sixth edition november 2017 addis ababa page i national guidelines for tb, drtb and leprosy in ethiopia foreword tuberculosis tb is a major public health problem throughout the world by infecting an estimated onethird of the worlds population and putting them at risk of. Worldwide, it is estimated that between 10 to 25% of tb infections occur extrapulmonarily, outside of the lungs. Evaluation of pulmonary and extrapulmonary tuberculosis in. Extra pulmonary tuberculosis eptb constitutes about 20% of all tb. A patient with both pulmonary and eptb is classified as a case of ptb. This is a retrospective cohort study of all patients treated for eptb in the state of texas. Before the advent of the hiv epidemic, approximately 85% of reported tuberculosis cases were pulmonary only, with the remaining 15% being extrapulmonary or both pulmonary and extrapulmonary sites 1.
Diagnosis and treatment of extrapulmonary tuberculosis. Tuberculosis is an infectiouscontagious disease, mainly caused by mycobacterium tuberculosis, which can be manifested in pulmonary ptb in 85% of cases and the rest in extra pulmonary form eptb. In many cases, m tuberculosis infection becomes latent before progression to active tb disease. There are many parts of the body which tuberculosis can affect, including the lymph nodes, nervous system as well as the bone and joints. Dec 11, 2018 home medterms medical dictionary az list extrapulmonary tuberculosis definition medical definition of extrapulmonary tuberculosis medical author. One large retrospective study 2 of tuberculosis in patients with advanced hiv infection reported. Nevertheless, its presentation can be extremely acute causing a. Clinical manifestation the symptoms of extra pulmonary tuberculosis depend on the sites if infection. Inhaled bacilli find their way into alveoli, here they begin dividing. Tuberculosis tb is one of the most prevalent infections of human beings and contributes considerably to illness and death around the world.
Tuberculosis is associated often with other serious disorders including. Extrapulmonary tb occurs when tuberculosis develops outside of the lungs, although extrapulmonary tb may coexist with pulmonary tb. Tuberculosis tb is caused by mycobacterium tuberculosis. Extrapulmonary tuberculosis is defined according to who classification criteria as an infection by rculosis which affects tissues and organs outside the pulmonary parenchyma. Extra pulmonary tuberculosis is the infection of tissues and organs other than the lungs by mycobacterium tuberculosis and a few related organisms. The natural history of pulmonary tuberculosis 2 slide 3 illustrates colonies of m. Definition of extrapulmonary tuberculosis medicinenet. Diagnosis and treatment of extrapulmonary tuberculosis ncbi. Learn more about how its spread, whos at risk, symptoms, treatment, and prevention. In the central nervous system, it acquires several forms including meningitis, tuberculoma, abscesses, cerebritis and miliary spread of mycobacterium tuberculosis. Tuberculosis outside the lung usually results from hematogenous dissemination.
Extrapulmonary tb definition of extrapulmonary tb by. New latent tb infection treatment guidelines are available. Mar 28, 2018 pulmonary tuberculosis tb is a contagious, infectious disease that attacks your lungs. People with the germ have a 10 percent lifetime risk of. It is very challenging the diagnosing eptb because the sample obtained from relatively inaccessible sites. We investigated the epidemiology of extrapulmonary tuberculosis tb among patients admitted to beijing chest hospital, beijing, china, during january 2008december 2017. Hiv infection, alcoholism, drug abuse chronic renal failure, clinical manifestations of pulmonary and extrapulmonary tuberculosis robert l. Before the advent of the hiv epidemic, approximately 85% of reported tuberculosis cases were pulmonary only, with the remaining 15% being extra pulmonary or both pulmonary and extra pulmonary sites 1.
Treatment for these types of tuberculosis does not differ from treatment regimens for pulmonary forms of the. Pulmonary and extra pulmonary abdominal tbcure patient and prevent the transmission of mycobacterium tuberculosis to other persons. If tb infection is not primarily located in the lungs, it is called extrapulmonary tb extra outside of, pulmonary affecting the lung. However, previous reports and genotypic molecular studies have shown that patients with smearnegative pulmonary tb could transmit tb to others. Miliary tb is a type of tuberculosis that has spread beyond your lungs. Patients with active pulmonary tb are isolated in negativepressure hospital rooms until they are culture negative and susceptibilities confirm that the organism is susceptible to the treatment. Comparison of pulmonary and extrapulmonary tuberculosis in. Extrapulmonary medical definition merriamwebster medical. In the uk tb has an incidence of around 1 in 10,000. Extra pulmonary tuberculosis symptoms, signs, causes. Clinical forms of pulmonary tuberculosis there such clinical forms of pulmonary tb, as milliary, disseminated, focal, infiltrative, tuberculoma, caseous pneumonia, fibrouscavernous, cirrhotic tuberculosis, primary tuberculosis complex. Predictors of pulmonary involvement in patients with extra. Pleural and ganglionar extra pulmonary tuberculosis are the most frequent forms, followed by genitourinary tuberculosis, symptoms of extra pulmonary tuberculosis depend on the affected organ.
Patients who are infected but who have no clinical, bacteriological, or radiographic evidence of active tb are said to have latent tb infection. Once a critical mass is reached a host immune response is elicited. Tuberculosis is classified as either pulmonary or extrapulmonary eptb. Neurotuberculosis osteoarticular tuberculosis cutaneous tuberculosis 3. This is significantly higher in london where incidence is 3. Pulmonary tuberculosis tb remains a major cause of morbidity and mortality worldwide, with about onethird of the worlds population infected. General signs and symptoms include fever, chills, night sweats, loss of appetite, weight loss. This field guide for the management of drugresistant tuberculosis is a practical tool intended to help health workers in the clinical and operational management of the disease with special focus on the introduction, implementation and management of the 9month treatment regimen for multidrugresistant tuberculosis. Tb outside the lung for the most part results from hematogenous dispersal.