Extrapulmonary tuberculosis is tuberculosis tb within a location in the body other than the lungs. Extra pulmonary tuberculosis symptoms, signs, causes, risk. Extrapulmonary tuberculosis tb refers to the haematogenous spread of mycobacterium tuberculosis pathology. Jan 09, 2015 extrapulmonary tuberculosis varied presentation difference in management slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
The clinical features of these diseases and complications may modify those of tuberculosis and so hinder diagnosis 10. Extrapulmonary tuberculosis and hiv infection extrapulmonary involvement can be seen in more than 50 percent of patients with concurrent aids and tuberculosis. Extrapulmonary tuberculosis eptb is defined as tuberculosis tb disease outside of the lung parenchyma 1. Extrapulmonary disease occurs in places other than the lungs, such as the larynx lymph nodes pleura brain kidney bones or joints in hivinfected persons, extrapulmonary disease is often accompanied by pulmonary tb. Extrapulmonary tb cases have significant proportion comparing pulmonary tb cases. If you continue browsing the site, you agree to the use of cookies on this website. However, similar studies from highburden countries like nepal are lacking. Epidemiology of extrapulmonary tuberculosis in the united.
This is produced by hematogenous and lymphatic spread of the m. Extrapulmonary tb occurs more commonly in immunosuppressed persons and young children. Extrapulmonary sites of infection commonly include lymph nodes, pleura, and osteoarticular areas, although any organ can be involved. Disease patterns since have changed, with a higher incidence of disseminated and extrapulmonary disease now found. The present report concerns a case of pulmonary nocardiosis in an immunocompetent host. Improving the diagnosis and treatment of smearnegative.
Extrapulmonary medical definition merriamwebster medical. Abdominal tuberculosis, which is a form of extrapulmonary tuberculosis, affects the gastrointestinal tract, spleen, pancreas, liver, peritoneum, omentum and lymph nodes adjacent to these organs. Rates of smearnegative pulmonary and extrapulmonary tuberculosis have been rising in countries with hiv epidemics. This ecdc video documentary featuring two patient stories illustrates how difficult the diagnosis of extrapulmonary tb can be. Comparison of pulmonary and extrapulmonary tuberculosis in. Although extrapulmonary tuberculosis eptb is less frequent than pulmonary tuberculosis ptb and is a secondary target for national tb control programs, its significance has increased worldwide during the hiv epidemic. The diagnosis of extrapulmonary tuberculosis can be elusive, necessitating a high index of suspicion. Derive from scratch by this method, body diagrams can be derived by pasting organs into one of the plain body images shown below. Diagnosis of extrapulmonary tuberculosis by smear, culture. Tuberculosis refers to an infectious disease associated with the lungs, which is mostly caused by bacteria. A new approach to the pathogenesis of extrapulmonary tuberculosis. Usa, the incidence of extrapulmonary tuberculosis ranged from 15 to 37 percent of all new cases of active tuberculosisl,2,4. The most common locations are the lymph nodes, pleura and the osteoarticular.
Who are the patients with extrapulmonary tuberculosis. Extrapulmonary tuberculosis approach bmj best practice. This article describes three cases of extrapulmonary tuberculosis eptb of the spine that presented to australian general practices. The most likely reasons are an increased recognition of extrapulmonary tuberculosis and an increasing. Much like pulmonary tb, eptb can occur as a primary infection or as reactivation of a latent focus with subsequent spread. In contemporary practice, clinicians neither start nor stop treatment for this condition based solely on pcr results. Diagnosing eptb remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. The basic principles of treatment for extrapulmonary tuberculosis eptb are the same as pulmonary tb with a few exceptions. The most common site for infection with mycobacterium tuberculosis worldwide is the lungs, but dissemination can occur to any part of the body, resulting in extrapulmonary tuberculosis eptb. Extrapulmonary tuberculosis has become more common. Extrapulmonary tuberculosis an overview sciencedirect. These are collectively denoted as extrapulmonary tuberculosis. The goals of treatment of tb are to cure the patient clinically and minimize the chance of relapse, and to prevent further transmission of tb to others. Epidemiological risk factors include birth in high tbprevalent countries, exposure at place of residencework in an institutional setting, and homelessness.
Diagnosis and treatment of extrapulmonary tuberculosis. Epidemiological risk factors include birth in high tb prevalent countries, exposure at place of residencework in an institutional setting, and homelessness. Comparative analysis of pulmonary and extrapulmonary. Department of internal medicine, national medical center, seoul, korea extrapulmonary tuberculosis eptb constitutes about 20% of all cases of tuberculosis tb in korea. Therapy for eptb requires a minimum of 6 months of treatment. This occurs in 1520% of active cases, causing other kinds of tb. The recent human immunodeficiency virus hiv and acquired immunodeficiency syndrome aids pandemic has resulted in changing epidemiology and has once again brought. Extrapulmonary tuberculosis free download as powerpoint presentation. Most common sites include lymph nodes 19%, pleura 7%, gastrointestinal tract 4%, bone 6%, cns 3% and. The high frequency is related to the failure of the immune response to contain m. For active tb disease, a small subset of patients 19. This infographic explains what tuberculosis and extrapulmonary tuberculosis is. This patient was diagnosed as having smear positive pulmonary tuberculosis and received supervised.
Extrapulmonary tubercuosis can occur as a primary form of the disease, i. Diagnosis of extrapulmonary and introduction paediatric. Jan 24, 2008 studies from developed countries have reported on hostrelated risk factors for extra pulmonary tuberculosis eptb. 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 can become active in other parts of the body, whether or not the lungs are involved. Epidemiology of extrapulmonary tuberculosis in brazil. Abstract up to 25% of tuberculosis cases present extrapulmonary involvement. Eptb refers to tb involving organs other than the lungs e. There are several hypotheses to explain the continuing prevalence of extrapulmonary tuberculosis. Clinical manifestations of pulmonary and extrapulmonary.
Nov 01, 2005 extrapulmonary involvement can be seen in more than 50 percent of patients with concurrent aids and tuberculosis. Apr 02, 2015 the two types of clinical manifestation of tuberculosis tb are pulmonary tb ptb and extrapulmonary tb eptb. There are various types under each type of tuberculosis. Extrapulmonary tuberculosis still constitutes approximately 20% of new cases in the us and a greater proportion of cases overseas. Extrapulmonary tuberculosis radiology reference article. Mar 24, 20 one in five tb patients in eueea has extrapulmonary tuberculosis. Please tell us where you read or heard it including the quote, if possible. Extrapulmonary tb eptb results from the hematogenous and lymphatic spread of rculosis bacilli. The objective of this study was to examine the epidemiology of eptb in brazil between 2007 and 2011. The current study aimed to outline and compare the demographic and clinical features of pulmonary and extrapulmonary tuberculosis cases in adults. Risk factors for extrapulmonary dissemination of tuberculosis and.
Up to 25% of tuberculosis cases present extrapulmonary involvement. Tuberculosis of bones and joints is mostly found in children, probably because of better vascularisation and oxygenation of osteoarticular structures during growth. While pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis ept is also an important clinical problem. Racgp extrapulmonary tuberculosis three cases in the spine. A retrospective analysis was carried out on 474 tuberculosis tb. It is usually caused by reactivation of latent infection and may cause disease at almost any site in the body. 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. Serafino wani mbbs, mrcp, msc trop meda diabetes mellitus, neoplastic diseases. Extrapulmonary involvement can occur in isolation or along with a pulmonary focus as in the case of patients with disseminated tuberculosis tb. During 200211, 167,652 cases of extrapulmonary tb were reported by the. Common sites of infection include the bones, kidneys, lymph nodes and central nervous system. Crosssectional study involving all cases of tb reported to the brazilian.
Tuberculosis tb is one of the main health issues in turkey. Pdf diagnosis and treatment of extrapulmonary tuberculosis. Often arthritis due to tb is a chronic monoarthritis, starting insidiously, with little or no pain and accompanied by joint. Disseminated tuberculosis occurs because of the inadequacy of host defenses in. 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. Diagnosis and treatment of extrapulmonary tuberculosis ji yeon lee, m.
In the uk, the proportion of eptb has increased relative to that of pulmonary tuberculosis tb. Burke from the royal edward laurentian hospital, montreal, quebec, canada certain recent studies have shown that some extrapulmonary lesions of tuberculous etiology, long held to be bloodborne in origin, are really the result of lymphogenous dissemination of tubercle bacilli. There are two types of tuberculosis, that are pulmonary tuberculosis and extrapulmonary tuberculosis. The denominator is the total number of eptb and ptb cases per year, excluding disseminated cases and concurrent extrapulmonarypulmonary tuberculosis cases. List of tuberculosis, extrapulmonary medications 3 compared. As a result of that spread and thanks to the development. Extrapulmonary tuberculosis is defined according to who classification criteria as an infection by m. Jun 24, 2015 tuberculosis is a disease that can involve every organ system. Tuberculosis may be classified according to site of disease as pulmonary or extrapulmonary. Extrapulmonary tuberculosis tb represents approximately 15% of all tb infections. Extrapulmonary tb eptb results from the hematogenous and lymphatic spread of m.
Tuberculosis is the most common fatal infectious disease in the world. Extrapulmonary tb disease may cause symptoms related to the part of the body that is affected table 4. Clinical manifestations of pulmonary and extrapulmonary tuberculosis robert l. Extrapulmonary tb may represent a sequel of primary infection or reactivation disease.
Extrapulmonary tuberculosis symptoms, diagnosis and. Medical records of 411 patients 190 women, 221 men. 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. Therefore, we carried out this study to compare demographic, lifestyle and clinical characteristics between eptb and ptb patients. Nov 15, 2009 trends in extrapulmonary tuberculosis eptb and pulmonary tuberculosis ptb, united states 19932006. Extrapulmonary tuberculosis in hivinfected patients. 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.