Clinical clues that should prompt suspicion of extrapulmonary tuberculosis are listed in. Handbook on tb laboratory diagnostic methods in the. For tb infection, the guide describes the available options for detection and their limitations. This ecdc video documentary featuring two patient stories illustrates how difficult the diagnosis of extrapulmonary tb can be. Tb most commonly affects lungs but however any organ or tissue can be involved. A total of 179 75% patients were tested for hiv within 1 year of the diagnosis of tuber. Guideline treatment of tuberculosis in adults and chil dren version 2. Of specific forms of eptb, lymphatic, pleural, and bone. The incidence of osseous eptb varies from being the most common site of eptb. For active tb, the guide organizes tests according to a concept developed by dr.
Guideline treatment of tuberculosis in adults and children. Extrapulmonary tb is most commonly encountered with concurrent pulmonary tb however this is not a pre requisite 2. Extrapulmonary tuberculosis still constitutes approximately 20% of new cases in the us and a greater proportion of cases overseas. 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. Patients with suspected tuberculosis should have appropriate specimens sent for acidfast bacillus afb staining, mycobacte rial culture, and histology. Serafino wani mbbs, mrcp, msc trop meda diabetes mellitus, neoplastic diseases. Pdf on dec 10, 2018, onix j cantresfonseca and others published extra pulmonary tuberculosis. Meningitis often occurs in the absence of infection at other extrapulmonary sites. Persons who have tb disease are usually infectious and may spread the bacteria to other people. At any age, meningitis is the most serious form of tb and has high morbidity and mortality. The lymph nodes are the most common site of extrapulmonary tb for both otherwise normal and hivinfected patients. Madhukar pai, see the bug, grow the bug, multiply the bug, and also describes drugsusceptibility testing dst and how to diagnose tb in special populations such as children, people with hiv, and people with extrapulmonary tb eptb. Clinical manifestations of pulmonary and extrapulmonary tuberculosis robert l.
Extrapulmonary and disseminated forms of tb sometimes require more extended treatment. Standards for diagnosis standard 1 this is a new standard emphasizing the responsibility of providers to be aware of individual and population risk factors for tuberculosis. Tuberculosis tb is the second leading cause of death due to infectious disease worldwide. It is a common opportunistic infection in people living with hivaids and other immunocompromised states. Pdf extrapulmonary tuberculosis eptb constitutes about 20% of all cases of tuberculosis tb in korea. If the file has been modified from its original state, some details such as the timestamp may not fully reflect those of the original file. Extrapulmonary tuberculosis tb infectious diseases. Exception may be necessary in central nervous system tb. Bhiva guidelines for the management of tb in adults living with hiv 7 1 scope and purpose the overall purpose of these guidelines is to help physicians manage adults with tuberculosis tb human.
This occurs in 1520% of active cases, causing other kinds of tb. Tb, eradicate projects and the resident tb technical advisor, centers for disease control and prevention, and the world health organization for their financial and technical contributions toward the development of this manual. Extrapulmonary centers for disease control and prevention. A positive result can be used as evidence of extrapulmonary tb and guide decision making because falsepositive results are unlikely. This is produced by hematogenous and lymphatic spread of the m.
Extrapulmonary tuberculosis is tuberculosis tb within a location in the body other than the lungs. This file contains additional information such as exif metadata which may have been added by the digital camera, scanner, or software program used to create or digitize it. Extrapulmonary tb as a general rule, the principles for the treatment of extrapulmonary tb disease parallels treatment of pulmonary tb. Systemic symptoms consistent with tb include fever. Extrapulmonary tuberculosis and hiv infection extrapulmonary involvement can be seen in more than 50 percent of patients with concurrent aids and tuberculosis. There are various types under each type of tuberculosis. Also known as generalized hematogenous tb, miliary tb occurs when a tuberculous lesion erodes into a blood vessel, disseminating millions of tubercle bacilli into the bloodstream and throughout the body. Extrapulmonary tuberculosis has become more common. To diagnose these types of tb other investigations must be used. Tb disease can occur in almost any anatomical site. These files will have pdf in brackets along with the filesize of the download. During 19972008, miliary disease was classified as both an extrapulmonary and a pulmonary form of tb.
Diagnosis of extrapulmonary and introduction paediatric. It can also be categorized as being either active or latent. List at least 4 extrapulmonary manifestations of tb and potential approaches to confirm the diagnosis explain the importance to evaluate for concomitant pulmonary tb describe differences in treatment where applicable to patients with extrapulmonary tb compared to pulmonary tb sites of involvement. Usa, the incidence of extrapulmonary tuberculosis ranged from 15 to 37 percent of all new cases of active tuberculosisl,2,4. Tuberculosis refers to an infectious disease associated with the lungs, which is mostly caused by bacteria. Causes 2 million deaths 2nd only to hiv as cause of death from infectious agent world wide among adults 3. Extrapulmonary tuberculosis free download as powerpoint presentation. Since the diagnosis of eptb is often compromised by the paucibacillary nature of the disease, new diagnostic tools and policies have been eagerly awaited. As a result of that spread and thanks to the development.
British hiv association guidelines for the management of. Hiv tb relationship has exacerbated problem with tb increasing in areas with high aids incidence especially subsaharan africa. Tuberculosis cases are decreasing but extrapulmonary tb does not show the same downward trend. Tuberculosis may be classified according to site of disease as pulmonary or extrapulmonary. Extrapulmonary tb may represent a sequel of primary infection or reactivation disease. 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. These are collectively denoted as extrapulmonary tuberculosis. Clinical presentation and diagnosis of tuberculosis. In countries with comprehensive diagnostic and reporting systems, extrapulmonary tb accounts for 2025% of reported cases. The abovementioned regimens are used in extrapulmonary resistant tb. Extrapulmonary tb accounts for 2025% of reported cases 2. Extrapulmonary tuberculosis by nationality, the netherlands. As a result, the proportion of extrapulmonary tb patients increased from 16% in 2002 to 22% in 2011 1 in every 5 tuberculosis patients has extrapulmonary tuberculosis 90 50 25 8 cases per 100 000 population extrapulmonary tuberculosis pulmonary. Information on extrapulmonary tb eptb patients is limited in many african.
Extrapulmonary tuberculosis an overview sciencedirect. Globally, extrapulmonary cases without concurrent pulmonary involvement comprised 14% of notified cases new and relapse in 2007. Uncontrolled massive dissemination can occur during primary infection or. Extrapulmonary tb presents at a range of sites in the body. Extrapulmonary tb occurs more commonly in immunosuppressed persons and young children. Extrapulmonary tuberculosis eptb is frequently a diagnostic and therapeutic challenge. Extrapulmonary tuberculosis is challenging to diagnose, but knowledge of its pathophysiology and imaging features can help the radiologist identify this infectious disease in highrisk patients. Uncontrolled massive dissemination can occur during primary infection or after reactivation of a latent focus.
Clinical presentation and diagnosis of tuberculosis 14 spontaneous sputum expectoration 3 specimens morning preferred sputum induction hypertonic saline if unable to expectorate sputum or expectorated sputum is afb smear and naat negative collection of respiratory specimens bronchoscopy. The prevalence of tuberculosis tb can be traced back to 24003400 bc, and the disease still continues to remain as the global threat affecting approximately 10 million people per year. We studied a total of 51 tb cases and 38 non tb control specimens. Diagnosing eptb remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Up to 25% of tuberculosis cases present extrapulmonary involvement. Extrapulmonary tuberculosis eptb constitutes about 20% of all cases of tuberculosis tb in korea. Nov 01, 2005 extrapulmonary involvement can be seen in more than 50 percent of patients with concurrent aids and tuberculosis. The confirmation of eptb has always been a challenge to laboratory personnel.
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 principles underlying the treatment of pulmonary tb also apply to extrapulmonary tb. Some extrapulmonary specimens may also be tested with the xpert assay such testing should be discussed with the laboratory. Mar 31, 2016 the most common forms of extrapulmonary tb are. In most series, the order of occurrence is lymph nodes, pleural, genitourinary, bones and joints, meninges, bowel and peritoneum, pericardium and the skin. Epidemiological risk factors include birth in high tb prevalent countries, exposure at place of residencework in an institutional setting, and homelessness.
Finally, the guide offers a comparison of all diagnostic methods see table. If you do not have it you can download adobe reader free of charge. Mar 24, 20 one in five tb patients in eueea has extrapulmonary tuberculosis. Clinical presentations of extrapulmonary tb eptb is diverse, leading to missed cases and delayed diagnoses. The two types of clinical manifestation of tuberculosis tb are pulmonary tb ptb and extrapulmonary tb eptb. Epidemiology of extrapulmonary tuberculosis in the united states, 19932006. Technical document handbook on tb laboratory diagnostic methods for the eu 1 background and introduction francis drobniewski tuberculosis tb is a major cause of morbidity and mortality in europe. Tb bacteria are aerosolized when a person who has pulmonary tb or tb affecting the larynx coughs, sneezes, laughs, or sings. The interactive core curriculum on tb is a webbased interactive course for clinicians on the cdc website. There are two types of tuberculosis, that are pulmonary tuberculosis and extrapulmonary tuberculosis.
Extrapulmonary tb eptb results from the hematogenous and lymphatic spread of m. Eptb patients were collected from tb registers, laboratory tb registers, treatment cards and tb medical personal files into a standardized study questionnaire. Tuberculosis is an airborne disease caused by a group of bacteria that is collectively referred to. Tb outside of the lung is called extrapulmonary tb. Tb remains as one of the top 10 causes of death worldwide, with 10 million people falling ill with tb and 1. Although tb most commonly affects the lungs, any organ or tissue can be involved. Diagnosis and treatment of extrapulmonary tuberculosis ncbi.
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. The most common locations are the lymph nodes, pleura and the osteoarticular. Tuberculosis the disease, its treatment and prevention. Demographic and clinical characteristics of the 239 somali patients who had extrapulmonary tuberculosis are summarized in the table. Extrapulmonary tuberculosis symptoms, diagnosis and.
In extrapulmonary tb without suspected or confirmed resistance to firstline antituberculosis drugs, the same regimen as in pulmonary tb is recommended. Racgp extrapulmonary tuberculosis three cases in the spine. 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. Diagnosis may be delayed as a result of nonspecific clinical manifestations that progress slowly and the low sensitivity of acidfast bacilli afb smear on extrapulmonary specimens. This method requires a graphics editor that can handle transparent images, in order to avoid white squares around the organs when pasting onto the body image.
The symptoms of pulmonary tb include cough, shortness of breath, chest pain, and hemoptysis. We investigated the epidemiology of extrapulmonary tuberculosis tb among patients admitted to beijing chest hospital, beijing, china, during january 2008december 2017. Ppt extrapulmonary tuberculosis powerpoint presentation. Eptb refers to tb involving organs other than the lungs e. The clinical features of these diseases and complications may modify those of tuberculosis and so hinder diagnosis 10. There are several hypotheses to explain the continuing prevalence of extrapulmonary tuberculosis.
Tb the disease, its treatment and prevention how is tb spread and am i likely to get infected. Extrapulmonary tuberculosis tuberculosis vertebral column. Infectious disease clinical tb outside the lungseg, lymph nodes, pleura, brain, kidneys, or bones. Extrapulmonary tb definition of extrapulmonary tb by. Chapter 2 transmission and pathogenesis of tuberculosis. Tuberculosis is the most common fatal infectious disease in the world. The guide will also note tests that are not recommended though are unfortunately still used.
Tb but can also affect other parts of the body, such as the brain, kidneys or spine extrapulmonary tb. An overview find, read and cite all the research you. Pdf diagnosis and treatment of extrapulmonary tuberculosis. A child is exposed to the tubercle bacilli when in contact with an adult or adolescent with infectious tb afb smear positive. This rapid communication aims to inform national tb programmes and other stakeholders about the key implications of the latest evidence on the use of specific molecular assays as initial diagnostic tests of pulmonary and extrapulmonary tb and rr tb, in adults and children. Clinical manifestations of pulmonary and extrapulmonary.
Apr 02, 2015 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. Although tb is spread through the air when people who have the disease cough or sneeze, it takes close and lengthy contact with an. Pdf most of the documents on the racgp website are in portable document format pdf. The progression from ltbi to tb disease may occur at any time, from soon to many years later. To open a pdf file you will need compatible software such as adobe reader.
Extrapulmonary 20% both 10% pleural 18% lymphatic 37% bonejoint 9% genitourinary 5% meningeal 4% other 23% cdc reported tb cases by form of disease united states, 2016 peritoneal 8% clinical presentation. Treatment of pulmonary and extrapulmonary tuberculosis. The most frequent forms of extrapulmonary tb observed were skeletal tb 41. The most likely reasons are an increased recognition of extrapulmonary tuberculosis and an increasing. Extrapulmonary tb eptb results from the hematogenous and lymphatic spread of rculosis bacilli. Derive from scratch by this method, body diagrams can be derived by pasting organs into one of the plain body images shown below. Treatment outcomes and risk factors of extrapulmonary tuberculosis. In 2014, there were an estimated 600 mdr tb cases in the country and only 34 mdr tb cases were notified ntlp data, 2014. A 6 month treatment regimen is recommended unless the isolated organisms are resistant to firstline drugs. In publications before 1997, miliary disease was classified as extrapulmonary tb, unless pulmonary disease was reported as the major disease site. Extrapulmonary tuberculosis tb represents approximately 15% of all tb infections. Extrapulmonary tuberculosis eptb constitutes about 15% to 20% of all cases of tuberculosis tb.
Diagnosis and treatment of extrapulmonary tuberculosis. An activists guide to tuberculosis diagnostic tools. We aim to evaluate the diagnostic potential of immunostaining with antimpt64 in various eptb specimens materials and methods. Treatment of pulmonary and extrapulmonary tuberculosis elsevier. Highquality laboratory diagnosis of tb is the basis for.
48 916 223 984 257 650 11 759 896 153 177 127 1201 479 246 240 1489 570 1001 1187 938 485 1109 985 473 1194 737 1127 379 1401 368 916 236 1024 228 677 1251 376 125 1243 425 1164 738 313 26 235