Extrapulmonary tuberculosis

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CT scan of peritoneal tuberculosis, with thickened omentum and peritoneal surfaces CT of peritoneal tuberculosis.jpg
CT scan of peritoneal tuberculosis, with thickened omentum and peritoneal surfaces

Extrapulmonary tuberculosis is tuberculosis (TB) within a location in the body other than the lungs. It accounts for an increasing fraction of active cases, from 20 to 40% according to published reports, [2] and causes other kinds of TB. [3] [4] These are collectively denoted as "extrapulmonary tuberculosis". [4] Extrapulmonary TB occurs more commonly in immunosuppressed persons and young children. In those with HIV, this occurs in more than 50% of cases. [4] Notable extrapulmonary infection sites include the pleura (in tuberculous pleurisy), the central nervous system (in tuberculous meningitis), the lymphatic system (in scrofula of the neck), the genitourinary system (in urogenital tuberculosis), and the bones and joints (in Pott disease of the spine), among others.

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Infection of the lymph nodes, known as tubercular lymphadenitis, is the most common extrapulmonary form of tuberculosis. [4] [5] An ulcer originating from nearby infected lymph nodes may occur and is painless. It typically enlarges slowly and has an appearance of "wash leather". [6]

Histopathological specimen showing tuberculosis of the duodenum. Lamina propria is stuffed with wall-to-wall histiocytes. This Kinyoun carbolfuchsin stain shows innumerable acid-fast bacilli. Mycobacterial Infection, Duodenum (4401445363).jpg
Histopathological specimen showing tuberculosis of the duodenum. Lamina propria is stuffed with wall-to-wall histiocytes. This Kinyoun carbolfuchsin stain shows innumerable acid-fast bacilli.

When it spreads to the bones, it is known as skeletal tuberculosis, [4] a form of osteomyelitis. [7] Tuberculosis has been present in humans since ancient times. [8]

Central nervous system infections include tuberculous meningitis, intracranial tuberculomas, and spinal tuberculous arachnoiditis. [4]

Gastrointestinal

Abdominal infections include gastrointestinal tuberculosis (which is important to distinguish from Crohn's disease, since immunosuppressive therapy used for the latter can lead to dissemination), tuberculous peritonitis, and genitourinary tuberculosis. [4]

A potentially more serious, widespread form of TB is called "disseminated tuberculosis", also known as miliary tuberculosis. [9] Miliary TB currently makes up about 10% of extrapulmonary cases. [10]

Pleural effusion

This condition is one of the common forms of extrapulmonary tuberculosis. It occurs during acute phase of the disease, with fever, cough, and pain while breathing (pleurisy). Pleural fluid usually contains mostly lymphocytes and the Mycobacterium bacteria. Gold standard of diagnosis is the detection of Mycobacterium in pleural fluid. Other diagnostic test includes the detection of adenosine deaminase (above 40 U/L) and interferon gamma in pleural fluid. [11]

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<span class="mw-page-title-main">BCG vaccine</span> Vaccine primarily used against tuberculosis

Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB). It is named after its inventors Albert Calmette and Camille Guérin. In countries where tuberculosis or leprosy is common, one dose is recommended in healthy babies as soon after birth as possible. In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated. Adults who do not have tuberculosis and have not been previously immunized, but are frequently exposed, may be immunized, as well. BCG also has some effectiveness against Buruli ulcer infection and other nontuberculous mycobacterial infections. Additionally, it is sometimes used as part of the treatment of bladder cancer.

<span class="mw-page-title-main">Tuberculosis</span> Infectious disease

Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in which case it is known as latent tuberculosis. Around 10% of latent infections progress to active disease which, if left untreated, kill about half of those affected. Typical symptoms of active TB are chronic cough with blood-containing mucus, fever, night sweats, and weight loss. It was historically referred to as consumption due to the weight loss associated with the disease. Infection of other organs can cause a wide range of symptoms.

<span class="mw-page-title-main">Pleurisy</span> Disease of the lungs

Pleurisy, also known as pleuritis, is inflammation of the membranes that surround the lungs and line the chest cavity (pleurae). This can result in a sharp chest pain while breathing. Occasionally the pain may be a constant dull ache. Other symptoms may include shortness of breath, cough, fever, or weight loss, depending on the underlying cause.

<span class="mw-page-title-main">Mycobacterial cervical lymphadenitis</span> Human medical condition

The disease mycobacterial cervical lymphadenitis, also known as scrofula and historically as king's evil, involves a lymphadenitis of the cervical lymph nodes associated with tuberculosis as well as nontuberculous (atypical) mycobacteria.

<span class="mw-page-title-main">Pleural effusion</span> Accumulation of excess fluid in the pleural cavity

A pleural effusion is accumulation of excessive fluid in the pleural space, the potential space that surrounds each lung. Under normal conditions, pleural fluid is secreted by the parietal pleural capillaries at a rate of 0.6 millilitre per kilogram weight per hour, and is cleared by lymphatic absorption leaving behind only 5–15 millilitres of fluid, which helps to maintain a functional vacuum between the parietal and visceral pleurae. Excess fluid within the pleural space can impair inspiration by upsetting the functional vacuum and hydrostatically increasing the resistance against lung expansion, resulting in a fully or partially collapsed lung.

Radiology (X-rays) is used in the diagnosis of tuberculosis. Abnormalities on chest radiographs may be suggestive of, but are never diagnostic of TB, but can be used to rule out pulmonary TB.

<span class="mw-page-title-main">Tuberculosis diagnosis</span>

Tuberculosis is diagnosed by finding Mycobacterium tuberculosis bacteria in a clinical specimen taken from the patient. While other investigations may strongly suggest tuberculosis as the diagnosis, they cannot confirm it.

<span class="mw-page-title-main">Tuberculosis management</span>

Tuberculosis management describes the techniques and procedures utilized for treating tuberculosis (TB).

<span class="mw-page-title-main">Parotitis</span> Medical condition

Parotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation.

<span class="mw-page-title-main">Miliary tuberculosis</span> Medical condition

Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and accounts for up to 20% of all extra-pulmonary tuberculosis cases.

AIDS-defining clinical conditions is the list of diseases published by the Centers for Disease Control and Prevention (CDC) that are associated with AIDS, and used worldwide as a guideline for AIDS diagnosis. CDC exclusively uses the term AIDS-defining clinical conditions, but the other terms remain in common use.

WHO Disease Staging System for HIV Infection and Disease in Adults and Adolescents was first produced in 1990 by the World Health Organization and updated in September 2005. It is an approach for use in resource limited settings and is widely used in Africa and Asia and has been a useful research tool in studies of progression to symptomatic HIV disease.

The current staging system for HIV infection in children was developed in 2005 and builds upon the staging system in place since 1987. A child is defined as someone under the age of 15. This staging system also requires the presence of HIV infection: HIV antibody for children aged 18 months or more; virological or p24 antigen positive test if aged under 18 months.

The CDC Classification System for HIV Infection is the medical classification system used by the United States Centers for Disease Control and Prevention (CDC) to classify HIV disease and infection. The system is used to allow the government to handle epidemic statistics and define who receives US government assistance.

<i>Mycobacterium avium-intracellulare</i> infection Medical condition

Mycobacterium avium-intracellulare infection (MAI) is an atypical mycobacterial infection, i.e. one with nontuberculous mycobacteria or NTM, caused by Mycobacterium avium complex (MAC), which is made of two Mycobacterium species, M. avium and M. intracellulare. This infection causes respiratory illness in birds, pigs, and humans, especially in immunocompromised people. In the later stages of AIDS, it can be very severe. It usually first presents as a persistent cough. It is typically treated with a series of three antibiotics for a period of at least six months.

A Rich focus is a tuberculous granuloma occurring within the cortex or meninges of the brain that ruptures into the subarachnoid space, causing tuberculous meningitis. The Rich focus is named for Arnold Rice Rich, a pathologist at Johns Hopkins Hospital, who along with his colleague Howard McCordock first described the post-mortem finding of caseous foci within the cerebral cortex or meninges which appeared to predate the development of meningitis. Prior to their research the prevailing view had been that meningitis occurred as a result of the dissemination of tuberculous bacilli associated with miliary tuberculosis and that these processes occurred at the same time.

<span class="mw-page-title-main">Tuberculous meningitis</span> Medical condition

Tuberculous meningitis, also known as TB meningitis or tubercular meningitis, is a specific type of bacterial meningitis caused by the Mycobacterium tuberculosis infection of the meninges—the system of membranes which envelop the central nervous system.

<i>Mycobacterium kansasii</i> Species of bacterium

Mycobacterium kansasii is a bacterium in the Mycobacterium genus. It is an environmental bacteria that causes opportunistic infections in humans, and is the one of the leading mycobacterial causes of human disease after tuberculosis and leprosy.

Carcinosis, or carcinomatosis, is disseminated cancer, forms of metastasis, whether used generally or in specific patterns of spread.

<span class="mw-page-title-main">Abdominal tuberculosis</span> Medical condition

Abdominal tuberculosis is a type of extrapulmonary tuberculosis which involves the abdominal organs such as intestines, peritoneum and abdominal lymph nodes. It can either occur in isolation or along with a primary focus in patients with disseminated tuberculosis.

References

  1. ↑ Akce, Mehmet; Bonner, Sarah; Liu, Eugene; Daniel, Rebecca (2014). "Peritoneal Tuberculosis Mimicking Peritoneal Carcinomatosis". Case Reports in Medicine. 2014: 1–3. doi: 10.1155/2014/436568 . ISSN   1687-9627. PMC   3970461 . PMID   24715911. CC-BY 3.0
  2. ↑ Mazza-Stalder J, Nicod L, Janssens JP (2012). "La tuberculose extrapulmonaire [Extrapulmonary tuberculosis]". Revue des Maladies Respiratoires. 29 (4): 566–578. doi:10.1016/j.rmr.2011.05.021. PMID   22542414.
  3. ↑ Ketata W, Rekik WK, Ayadi H, Kammoun S (2015). "Les tuberculoses extrapulmonaires [Extrapulmonary tuberculosis]". Revue de Pneumologie Clinique. 71 (2–3): 83–92. doi:10.1016/j.pneumo.2014.04.001. PMID   25131362.
  4. 1 2 3 4 5 6 7 Golden MP, Vikram HR (2005). "Extrapulmonary tuberculosis: an overview". American Family Physician. 72 (9): 1761–8. PMID   16300038.
  5. ↑ Rockwood, RR (August 2007). "Extrapulmonary TB: what you need to know". The Nurse Practitioner. 32 (8): 44–9. doi:10.1097/01.npr.0000282802.12314.dc. PMID   17667766.
  6. ↑ Burkitt, H. George (2007). Essential Surgery: Problems, Diagnosis & Management 4th ed. p. 34. ISBN   9780443103452.
  7. ↑ Kumar V, Abbas AK, Fausto N, Mitchell RN (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 516–522. ISBN   978-1-4160-2973-1.
  8. ↑ Lawn, SD; Zumla, AI (2 July 2011). "Tuberculosis". Lancet. 378 (9785): 57–72. doi:10.1016/S0140-6736(10)62173-3. PMID   21420161. S2CID   208791546.
  9. ↑ Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphael (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. pp. Chapter 250. ISBN   978-0-443-06839-3.{{cite book}}: |first= has generic name (help)
  10. ↑ Ghosh, editors-in-chief, Thomas M. Habermann, Amit K. (2008). Mayo Clinic internal medicine: concise textbook. Rochester, MN: Mayo Clinic Scientific Press. p. 789. ISBN   978-1-4200-6749-1. Archived from the original on 6 September 2015.{{cite book}}: |first= has generic name (help)
  11. ↑ Zhai K, Lu Y, Shi HZ (July 2016). "Tuberculous pleural effusion". Journal of Thoracic Disease. 8 (7): E486–94. doi:10.21037/jtd.2016.05.87. PMC   4958858 . PMID   27499981.
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