A18.0-9
Note: notifiable medical condition.
DESCRIPTION
Extra-pulmonary tuberculosis is defined as infection of organ systems other than the lung with Mycobacterium tuberculosis. Extra-pulmonary TB can present with non-specific symptoms such as unintentional weight loss (> 1.5kg in a month), night sweats and fever for more than 2 weeks. Other symptoms depend on the organ affected. The most common types of extra-pulmonary TB are listed below along with commonly associated signs and symptoms:
| Extra-pulmonary TB typ e | Common presenting sign/symptom |
|---|---|
| TB lymphadenitis |
» Audible wheeze or typical brassy cough caused by large mediastinal lymph nodes » Peripheral TB lymphadenopathy occurs in neck and armpits. Typically nodes are large (>2cm), tender, non-symmetrical, matted, firm to fluctuant and rapidly growing. |
|
TB pleural effusion (usually single-sided) |
» Non-productive cough. » Chest pain. » Shortness of breath. » High temperature. » Tracheal and mediastinal shift away from the side of the effusion. » Decreased chest movement. » Stony dullness on percussion on the side of the effusion. |
|
TB of spine, bones and joints |
» Decreased movement in the joints. » Excessive sweating, especially at night. » Joint swelling with warm, tender joints. » Low-grade fever. » Muscle atrophy and/or spasms. » Numbness, tingling, or weakness below the infection (if the spine is involved). |
| TB pericardium |
» Chest pain. » Shortness of breath. » Dizziness and weakness from low cardiac output » Signs and symptoms of right-sided heart failure (tachycardia, low BP, peripheral oedema, liver congestion, ascites). |
| TB meningitis |
» During the early phase of TB meningitis, malaise, low-grade fever, headache and personality change may be present. » With suspected established infection assess for: - gradual onset of headache - malaise - confusion - decreased consciousness - vomiting - neck stiffness and positive Kernig’s sign » In children, TB meningitis may be acute, sub-acute or chronic and typically presents between 23-49 months of age with: - altered level of consciousness - history of fever - irritability - headache - convulsions - poor feeding and failure to thrive, - vomiting, - cough, - meningism |
| Disseminated/miliary TB |
» Most often seen in children and young adults. » Fever. » Cough. » Generalised lymphadenopathy. » Hepatomegaly. » Consider in febrile patients presenting with HIV wasting syndrome. |
| TB empyema | » Similar to pleural effusion, but aspiration reveals thick pus. |
| TB peritoneum |
» Ascites with no signs of portal hypertension. » Possible palpable abdominal masses. » Possible bowel obstruction. |
REFERRAL
All suspected cases of extra-pulmonary TB should be referred immediately to secondary or tertiary care for diagnosis and further management.