To protect against this, the United States employs a strategy of preventive therapy or treatment of latent TB infection. Masks are required for all patients, visitors, employees and staff. Thank you. Tuberculosis: Types. Make an Appointment. Reviewed by Dr. Ulcers of the mouth and oropharynx may develop from eating M. Intestinal invasion generally causes hyperplasia and an inflammatory bowel syndrome Overview of Inflammatory Bowel Disease Inflammatory bowel disease IBD , which includes Crohn disease and ulcerative colitis, is a relapsing and remitting condition characterized by chronic inflammation at various sites in the gastrointestinal It may also mimic appendicitis Appendicitis Appendicitis is acute inflammation of the vermiform appendix, typically resulting in abdominal pain, anorexia, and abdominal tenderness.
Diagnosis is clinical, often supplemented by CT or ultrasonography Ulceration and fistulas are possible. Liver infection is common in patients with advanced pulmonary TB and widely disseminated or miliary TB.
However, the liver generally heals without sequelae when the principal infection is treated. TB in the liver occasionally spreads to the gallbladder, leading to obstructive jaundice. TB may infect the wall of a blood vessel and has even ruptured the aorta. Adrenal involvement, leading to Addison disease, formerly was common but now is rare.
Tubercle bacilli may spread to tendon sheaths tuberculous tenosynovitis by direct extension from adjacent lesions in bone or hematogenously from any infected organ. Acid-fast staining, microscopic analysis, and mycobacterial culture of fluid and tissue samples, and, when available, nucleic acid—based testing. Testing is similar to that for pulmonary TB see Diagnosis Diagnosis Tuberculosis TB is a chronic, progressive mycobacterial infection, often with a period of latency following initial infection.
TB most commonly affects the lungs. Symptoms include productive Nucleic acid—based testing can be done on fresh fluid or biopsy samples and on fixed tissue eg, if TB was not suspected during a surgical procedure and cultures were not done.
However, cultures and smears of body fluids and tissues are often negative because few organisms are present; in such cases, nucleic acid amplification tests NAAT may be helpful.
Typically, lymphocytosis is present in body fluids. A very suggestive finding in the CSF is a glucose level If all tests are negative and miliary TB is still a concern, biopsies of the bone marrow and the liver are done. Chest x-ray may show signs of primary or active TB; in miliary TB, it shows thousands of 2- to 3-mm interstitial nodules evenly distributed through both lungs.
Other imaging tests are done based on clinical findings. Abdominal or GU involvement usually requires CT or ultrasonography; renal lesions are often visible.
If it is not, the diagnosis of TB should be questioned or causes of anergy sought. Drug treatment is the most important modality and follows standard regimens and principles see First-line drugs First-line drugs Tuberculosis TB is a chronic, progressive mycobacterial infection, often with a period of latency following initial infection. Six to 9 mo of therapy is probably adequate for most sites except the meninges, which require treatment for 9 to 12 mo.
Corticosteroids may help in pericarditis and meningitis for dosing, see Other treatments Other treatments Tuberculosis TB is a chronic, progressive mycobacterial infection, often with a period of latency following initial infection. Drug resistance is a major concern; it is increased by poor adherence, use of too few drugs, and inadequate susceptibility testing.
Surgical debridement is sometimes needed in Pott disease to correct spinal deformities or to relieve cord compression if there are neurologic deficits or pain persists; fixation of the vertebral column by bone graft is required in only the most advanced cases.
Surgery is usually not necessary for TB lymphadenitis except for diagnostic purposes. Tuberculous lymphadenopathy in adults: a review of 35 cases. Acta Chir Belg. Ten years of extra-pulmonary tuberculosis in a Danish university clinic. Scand J Infect Dis. Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management.
Postgrad Med J. Isolated peripheral tuberculous lymphadenitis in adults: current clinical and diagnostic issues. Comparison of mycobacterial lymphadenitis among persons infected with human immunodeficiency virus and seronegative controls.
Tuberculous pleural effusion. Twenty-year experience. Tuberculous pleurisy: a study of patients. Arch Intern Med. Computed tomography findings of tuberculous pleurisy. Int J Tuberc Lung Dis. Kataria YP, Khurshid I. Adenosine deaminase in the diagnosis of tuberculous pleural effusion.
Light RW. Establishing the diagnosis of tuberculous pleuritis. Evaluation of polymerase chain reaction for detection of Mycobacterium tuberculosis in pleural fluid. Bone and joint tuberculosis—a year review. Isr J Med Sci. Tuberculosis of bones and joints. J Bone Joint Surg Am. Tuberculous spondylitis in adults. Int Orthop. The pathogenesis of tuberculous meningitis. Bull Johns Hopkins Hosp ;— Tuberculous meningitis.
N Engl J Med ;— Med Clin North Am. Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis. Activity of adenosine deaminase in cerebrospinal fluid for the diagnosis and follow-up of tuberculous meningitis in adults. J Infect Dis. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med.
Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. Talwani R, Horvath JA. Tuberculous peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: case report and review. Christensen WI. Genitourinary tuberculosis: review of cases. Genito-urinary tuberculosis. Clinical features in a general hospital population. Am J Med. Munt PW. Miliary tuberculosis in the chemotherapy era: with a clinical review in 69 American adults.
Miliary tuberculosis: epidemiology, clinical manifestations, diagnosis, and outcome. Rev Infect Dis. Tuberculous pericarditis: optimal diagnosis and management. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. Tuberculosis following the use of etanercept, a tumor necrosis factor inhibitor. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
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Extrapulmonary Tuberculosis: An Overview. C 7 , 8 All confirmed cases of active tuberculosis should be reported to the local health department. C 7 Adjunctive corticosteroid therapy is recommended, based on limited evidence, in patients with tuberculous meningitis or pericarditis, and in miliary tuberculosis with refractory hypoxemia.
However, there may have been some selection bias in terms of who was tested for HIV, masking a difference in HIV positivity between the groups. The most common site of EPTB was the lymph nodes Other sites were miliary 7. Fifteen EPTB patients 5. The results of the multi-variate logistic regression analyses are presented in Table 2. To our knowledge no similar study has been reported from other south Asian countries or other high TB burden countries.
In our study, the lymph nodes were the most common site of EPTB. Earlier studies have suggested that localization of EPTB may be variable. Results of our study are comparable to two studies from Turkey [ 5 , 6 ] which reported that lymph nodes accounted for nearly half the cases of EPTB. In some studies clinical diagnosis of lymph node tuberculosis has been strengthened by a positive culture of Mycobacterium tuberculosis complex [ 3 , 6 , 11 ].
Therefore, we cannot rule out some mis-diagnosis of lymph node TB. But in our study, proportions of PTB and EPTB were almost same, possibly because it was carried out in the main referral centre for the region and the proportion of EPTB may be higher due to availability of diagnostic facilities.
Pulmonary TB cases are also diagnosed at primary health care centres because of the decentralization of diagnostic and treatment facilities under NTP. This means that they are often never referred to MTH. Gender differences observed in our study confirm the findings of previous studies in both developing [ 16 , 17 ] and developed countries [ 18 , 19 ]. This may be a consequence of gender differences in both exposures to TB infection and prevalence of susceptibility risk factors e. Other possible factors accounting for the difference are stigma associated with having TB and lack of access to health care, especially for females, in some developing countries like Nepal [ 17 ].
These inconsistencies could be due to differences in prevalence of host-related factors or important co-exposures. In our study, only 4. Proportions of "ever smokers" differed between males This raises the possibility that the age and sex differences between PTB cases in whom smoking was more common and EPTB cases could be a result of confounding by smoking.
However, after adjusting for potential confounding factors including smoking by logistic regression analysis, younger age and female gender remained strongly associated with EPTB. Therefore, after primary infection in the lungs the probability of reactivation at an extra-pulmonary site may be higher at younger age. It would be useful to confirm the association of age and gender with EPTB in other high-burden countries. Our results suggest that at older ages reactivation of TB was common in the lungs.
This may be due to decreased local immunity in the lungs in the elderly as a result of associated life-style factors smoking or co-morbid conditions which may predispose to re-activation in the lungs.
A recent study from the UK has reported that co-morbid conditions like emphysema and bronchitis were independent risk factors for PTB [ 20 ]. In our study, smoking was associated with PTB.
This is consistent with a meta-analysis which reported that smoking is a risk factor for TB infection and for pulmonary TB disease [ 21 ].
Another report has suggested that smoking is associated with relapse of TB and smokers are less likely to have isolated extrapulmonary TB [ 22 ]. We also found that past history of TB was associated with PTB, although we could not identify if this was as a result of reactivation relapse or reinfection [ 23 ]. However, evidence suggests that in high-burden countries reinfection is more common than relapse [ 24 ]. Therefore history of smoking and contact with a case of TB should arouse a high degree of suspicion for active TB.
Such information would be useful for screening the patients for TB. Currently there are no health education campaigns or legislation regarding sales of cigarettes in Nepal. This is significant public health concern in view of tuberculosis control.
Our results are consistent with other studies that have reported an association between diabetes mellitus and PTB [ 25 , 26 ].
We carried out a logistic regression analyses excluding those cases which were HIV-positive. The results of our main logistic regression analyses did not change. The current rate may be higher, but probably not high enough to make a substantive difference to our conclusions. Our study had several other limitations. Information about life style factors was sometimes incompletely recorded in the files.
Therefore, we could not study the effect of amount and duration of smoking and alcohol use on EPTB. Hence, the cases we studied may not be representative of those occurring in the general population. Information about nutritional status and microbial factors was not available from the case files in our setting.
There may be some risk factors common to both forms of TB that could not be identified by our analysis. Whether this is common to other high-burden countries also is yet unclear. Further studies in other high burden countries are needed.
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