In those with hiv, this occurs in more than 50% of cases. Extrapulmonary tuberculosis radiology reference article. Mycobacterium tuberculosis is the bacterium that as a single agent is known to cause the infection with the most morbidity and mortality around the world. Extrapulmonary and disseminated forms of tb sometimes require more extended treatment. Epidemiological risk factors include birth in high tbprevalent countries, exposure at place of residencework in an institutional setting, and homelessness. Body fluid or tissue from the disease site should be collected for afb smear and culture see chapter 5, treatment for latent tuberculosis infection. The treatment of tuberculosis in general, is standardized by various.
Pdf diagnosis and treatment of extrapulmonary tuberculosis. Extrapulmonary tuberculosis approach bmj best practice. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Tuberculosis tb is an infectious disease usually caused by mycobacterium tuberculosis mtb bacteria.
Usa, the incidence of extrapulmonary tuberculosis ranged from 15 to 37 percent of all new cases of active tuberculosisl,2,4. Persons who have tb disease are usually infectious and may spread the bacteria to other people. The highest numbers by country of birth were from india, which had 189 cases. Extrapulmonary tuberculosis tb infectious diseases. In the us, it is most common among the elderly and immunocompromised, but in areas where tb is common among children, tb meningitis usually occurs between birth and 5 yr. Tb bacilli often infect the lymph nodes in the neck and above the clavicles the thin bone underneath the shoulders, which then swell and inflame the surrounding skin. Extrapulmonary tb may occur in multiple sites, with relative frequencies of 42 for lymphatic, 18 for pleural, 12 for bone or joint, 6 for genitourinary, 6 for meningeal, 5 for peritoneal, and 11 for other sites. Most infections do not have symptoms, in which case it is known as latent tuberculosis. Acidfast bacilli afb smear of biological specimens is often negative. Tuberculin skin testing tst and interferongamma release assays igras are adjunctive diagnostic tools, at best. Active tb can develop in many other parts of the body, in particular lymph nodes, meninges, vertebrae, joints, kidneys, genital organs and the abdominal cavity. Department of internal medicine, national medical center, seoul, korea extrapulmonary tuberculosis eptb constitutes about 20% of all cases of tuberculosis tb in korea. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters.
Preventing tb using the 4 is treatment of active tb. Extrapulmonary tuberculosis still constitutes approximately 20% of new cases in the us and a greater proportion of cases overseas. Diagnosis and treatment of extrapulmonary tuberculosis ji yeon lee, m. Extrapulmonary tb may represent a sequel of primary infection or reactivation disease. Many forms of extrapulmonary tb eptb are paucibacillary, and the diagnosis of eptb is therefore challenging. Tuberculosis may be classified according to site of disease as pulmonary or extrapulmonary. Extra pulmonary tuberculosis symptoms, signs, causes. Eefje jong, md, phd clinical hiv research unit tb focal point, helen joseph hospital tbhiv symposium 16 sept 2012. When the infection occurs in other parts of the body it is called extrapulmonary tuberculosis. Immigration is a major factor in sustaining tuberculosis. The most likely reasons are an increased recognition of extrapulmonary tuberculosis and an increasing. These are collectively denoted as extrapulmonary tuberculosis. Extrapulmonary tuberculosis eptb now represents about half of all diagnosed cases of tb in the uk and is seen increasingly in patients with immunosuppression or hiv.
If you continue browsing the site, you agree to the use of cookies on this website. Extrapulmonary tuberculosis has become more common. The symptoms of extra pulmonary tuberculosis are more varied, but fever and weight loss are present in the majority of cases. However, the liver generally heals without sequelae when the principal infection is treated. The progression from ltbi to tb disease may occur at any time, from soon to many years later. To this end, it is very important to combine multiple drugs, especially drugs with bactericidal.
Extrapulmonary tuberculosis eptb is defined as tuberculosis tb disease outside of the lung parenchyma 1. Extrapulmonary tuberculosis is defined according to who classification criteria as an infection by rculosis which affects tissues and organs outside the pulmonary parenchyma. Before discussing the epidemiology of extrapulmonary tuberculosis eptb. This ecdc video documentary featuring two patient stories illustrates how difficult the diagnosis of extrapulmonary tb can be.
Extrapulmonary tb eptb is a type of infection that may occur in any organ of the body other than lung. Extrapulmonary tuberculosis is tuberculosis tb within another location in the body than the lungs. Extrapulmonary tuberculosis tb refers to the haematogenous spread of mycobacterium tuberculosis pathology. Although data are limited, extrapulmonary disease is a common presentation of tuberculosis tb in brazil. Chapter 2 transmission and pathogenesis of tuberculosis. To minimize the interval between clinical manifestation of disease and diagnosis, clinicians should maintain an increased level of suspicion for extrapulmonary tuberculosis in somali patients. Extrapulmonary tuberculosis eptb constitutes about 20% of all cases of tuberculosis tb in korea. Pdf pattern diagnosis and treatment outcome of extra pulmonary. Diagnosing eptb remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Diagnosis and treatment of extrapulmonary tuberculosis.
The interactive core curriculum on tb is a webbased interactive course for clinicians on the cdc website. This occurs in 1520% of active cases, causing other kinds of tb. Methods a search of medlinepubmed with the keywords epidemiology, extrapulmonary, tuberculosis, urogenital was made and the most recent articles. One of the reasons for the incorrect estimation of the epidemiology of extrapulmonary tb eptb is a difference in terminology. One in five tb patients in eueea has extrapulmonary tuberculosis. Extrapulmonary tuberculosis and hiv infection extrapulmonary involvement can be seen in more than 50 percent of patients with concurrent aids and tuberculosis. Diagnosis of extrapulmonary and introduction paediatric.
Young children and hiv infected adults are more susceptible. People suspected of having tb disease should be given a diagnostic evaluation as soon as possible see chapter 4, diagnosis of tuberculosis disease. Treatment of pulmonary and extrapulmonary tuberculosis elsevier. Liver infection is common in patients with advanced pulmonary tb and widely disseminated or miliary tb. Epidemiology of extrapulmonary tuberculosis in brazil. Extrapulmonary tb eptb results from the hematogenous and lymphatic spread of rculosis bacilli. This is one reason for confusion with the proportions of eptb ettb forms. Extrapulmonary tb presents at a range of sites in the body. Extrapulmonary tuberculosis multiple sites radiology. There are various types under each type of tuberculosis. Racgp extrapulmonary tuberculosis three cases in the spine. Signs and symptoms of pulmonary and extrapulmonary tb.
Extrapulmonary tuberculosis is tuberculosis tb within a location in the body other than the lungs. Meningitis often occurs in the absence of infection at other extrapulmonary sites. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. Extrapulmonary tb part 1 extrapulmonary tb part 2 this is the currently selected item. There are several hypotheses to explain the continuing prevalence of extrapulmonary tuberculosis. Methods a search of medlinepubmed with the keywords epidemiology, extrapulmonary, tuberculosis, urogenital was made and the most recent articles analysed for the incidence rate, prevalence and. Extrapulmonary tuberculosis an overview sciencedirect. In australia in 2007, there were 1086 new cases of tb 5. In extrapulmonary tb without suspected or confirmed resistance to firstline. A national literature search demonstrated that the epidemiology of eptb is infrequently mentioned. Much like pulmonary tb, eptb can occur as a primary infection or as reactivation of a latent focus with subsequent spread. Extrapulmonary centers for disease control and prevention. Tb in the liver occasionally spreads to the gallbladder, leading to obstructive jaundice.
It is usually caused by reactivation of latent infection and may cause disease at almost any site in the body. Both the hiv epidemic and changes in population demographics, with rising numbers of immigrants, are being held responsible for this proportional increase of extrapulmonary tb 6,7 9. It most commonly affects the lungs where it is called pulmonary tb. Introduction tb, is an airborne infectious disease caused by mycobacterium tuberculosis. Extrapulmonary tubercuosis can occur as a primary form of the disease, i. Extrapulmonary tuberculosis germaine jacquette, md clinical assistant professor njms global tuberculosis institute may 4, 2012 tb cases by site of disease united states, 2000 2010 year total cases pulmonary extrapulmonary 2000 16, 309, 086 80% 3, 211 20% 2001 15, 945 12, 724 3, 217 2002 15, 055 11,901 3, 148 2003 14 83514, 835 11. Tuberculosis refers to an infectious disease associated with the lungs, which is mostly caused by bacteria. Infectious disease clinical tb outside the lungseg, lymph nodes, pleura, brain, kidneys, or bones. This individual was from south east asia, hiv negative, with pathologically proven extensive pulmonary and extrapulmonary tuberculosis.
Diagnosis may be delayed as a result of nonspecific clinical manifestations that progress slowly and the low sensitivity of acidfast baci. Tuberculosis is the most common fatal infectious disease in the world. Extrapulmonary tuberculosis varied presentation difference in management slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Delayed diagnosis of extrapulmonary forms is frequent and it entails an increased morbidity and mortality. Clinicians and other hcws should suspect tb disease in people who have any of the symptoms listed in table 7.
Thought to represent maybe 10 or 15% of cases of extrapulmonary tb, as opposed to lymph nodes, thats more like 35%. As a result of that spread and thanks to the development. Extrapulmonary tb occurs more commonly in immunosuppressed persons and young children. Extrapulmonary involvement can be seen in more than 50 percent of patients with concurrent aids and tuberculosis. As is true of any infection that can involve the genitourinary site, the kidneys and the genital area, the patients may have very nonspecific. Extrapulmonary tb definition of extrapulmonary tb by. The most important risk factors for eptb are shown in table 1. The lymph nodes are the most common site of extrapulmonary tb for both otherwise normal and hivinfected patients. Extrapulmonary tuberculosis complications bmj best. Pdf extrapulmonary tuberculosis eptb constitutes about 20% of all cases of. At any age, meningitis is the most serious form of tb and has high morbidity and mortality. Tuberculosis is the most common fatal infectious disease in. The most common sites of extrapulmonary disease are as follows the pathology of these lesions is similar to that of pulmonary lesions.
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