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Extrapulmonary Tuberculosis: Another Form Of Tuberculosis

Man coughing – Evanto Elements

Tuberculosis is one of the leading causes of death globally causing an estimated 4500 deaths daily. Tuberculosis has been described in different cultures and historical texts from hundreds of years ago making it one of humanity’s greatest killers. In prehistoric times, tuberculosis was called consumption as it tends to slowly consume affected persons till the end of their life (weight loss).

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Tuberculosis is a serious and sometimes lethal infection of the body caused by a slow-growing bacterium called Mycobacterium. There are different types of Mycobacterium but the most common one responsible for the greatest number of tuberculosis infection is called Mycobacterium tuberculosis. This bacterium primarily infects the lungs and causes tuberculosis over time, typically leading to a reduction in one’s quality of life or death.

When a person with tuberculosis coughs, talks or sneezes, the bacteria escape air droplets and can linger in the air for a while before dropping to the floor. A single cough can generate about 3000 infectious droplets which when inhaled by an uninfected person who has not been vaccinated, bacteria nestle in the body. During this time in the air, tuberculosis can be transmitted when an uninfected or unvaccinated person comes into contact with these droplets. In ideal situations, the body’s immune system can prevent the bacterium from growing and causing active disease but in individuals with a weakened immune system, the bacterium continues to grow.

Other affected parts
While tuberculosis is a disease of the lungs, the bacteria can infect other parts of the body. This occurs when the bacteria move from the lungs to areas directly in contact with the lungs or spread via blood vessels to afar away areas. When this happens, it is called extrapulmonary tuberculosis. Infants and very young children, and people infected with the human immunodeficiency virus (HIV) have an increased risk of developing extrapulmonary TB. It is estimated that 1 in every 5 persons with tuberculosis has extrapulmonary TB. Affected persons note new symptoms in these areas which lead their healthcare team to discover the new infection. While lung (or primary) tuberculosis is well known, extrapulmonary tuberculosis is not often discussed.

Tuberculosis Photo CDC

The following are the commonest areas affected by tuberculosis outside the lungs:

Lymph nodes
These are small glands of the immune system tissues that help in fighting against infections by filtering them out. They are present all over the body and seek to arrest any serious infectious agent or tumour– think police stations. They are also the commonest area that tuberculosis goes to apart from the lungs. This typically causes fever, weight loss and night sweats in affected persons.

Pleura
The pleura is a two-layered membrane that covers the lungs and helps cushion the lungs. It also reduces friction between the lungs and the bony structures surrounding them. It is another common area that tuberculosis may spread to, causing a cough, chest pain and difficulty breathing.

The bones or joints
Tuberculosis is commonly FROM the lung to the bones by both direct contact and via the blood supply. The most commonly affected bones are the bones of the spine (backbone) and bones of the hip and knees. Affected persons often report bone pain, weakness, swelling and reduced range of movement in affected bones or joints.

Tissues covering the surface of the brain and spinal cord
Tuberculous meningitis is the inflammation of the covering of the brain and spinal cord due to tuberculosis. This is especially of note because it leads to severe outcomes and death in affected persons. Symptoms may include impairment of consciousness, seizures, malaise, headache, fever, or personality change.

The reproductive organs
In men, genital tuberculosis usually follows tuberculosis of the kidneys. There is an affectation of the prostate, seminal vesicles, epididymis, and testes. The affected person often has a swelling in the scrotum. In women, genital tuberculosis can spread to the uterus, ovaries, cervix, and vagina. Affected persons often have pelvic pain, infertility and vaginal bleeding. In both men and women, there may be fever and back pain.

It is advisable to see a doctor to diagnose TB. Photo NPR

How is extrapulmonary tuberculosis treated?
Treatment is instituted via medications which are taken for months. Health workers often directly ensure that individuals diagnosed with tuberculosis take their medicine daily via a method called directly observed therapy. Extrapulmonary TB is usually treated with a combination of four medicines for 6 to 9 months, followed by another 4 to 7 months of treatment with two medicines.

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