Extrapulmonary Tuberculosis: When TB Spreads From the Lungs

What Is Extrapulmonary Tuberculosis?

Tuberculosis (TB) is a disease caused by the bacterium known as Mycobacterium tuberculosis. The bacteria commonly target the lungs, but it can also infect other organs such as the meninges, abdomen, genitourinary tract, bones, and the like. This type of TB is known as extrapulmonary tuberculosis.

Those who are diagnosed with HIV are at a greater risk of tuberculosis. In most cases, people who are HIV-positive can have both pulmonary and extrapulmonary TB disease at the same time.

What Causes Extrapulmonary Tuberculosis?

Most extrapulmonary tuberculosis cases occur when the TB bacteria from the lungs infects other organs via the bloodstream.

Is Extrapulmonary Tuberculosis Infectious?

It is important to note that while TB of the lungs is usually contagious, persons who have extrapulmonary disease are not as infectious, unless:

• They are also infected with pulmonary tuberculosis.
• Their extrapulmonary TB case is situated at the oral cavity or around the larynx.
• If their extrapulmonary TB forms abscesses which are infected with foreign organisms.

Signs and Symptoms of Extrapulmonary Tuberculosis

The symptoms of extrapulmonary TB differ depending on which body part or organ is affected.

TB Lymphadenitis

This form of TB affects the lymph nodes. It usually infects the nodes around the neck, but it may also affect nodes in other areas. This is one of the most common types of extrapulmonary tuberculosis.

The most obvious sign would be a swollen and usually painless bump around the neck caused by an enlarged lymph node. Other symptoms may include:

• Fever
• Lethargy or tiredness
• Sudden weight loss
• Night sweats

Genitourinary TB

This urinary disease is the second most common kind of extrapulmonary TB. Genitourinary TB may be caused by bacteria in the bloodstream or infected lymph nodes. It affects a person’s kidneys, but it may also affect the urinary track or the genitals. It is contagious, with some reported cases stating that it is able to spread through sexual intercourse.

Those with genitourinary TB may find ulcers either on the genitals or the urinary tract. Other symptoms include:

• Swelling of the testicles
• Painful urination sensation
• Less urine expelled
• Chronic back and pelvic pain
• Less semen volume
• Impotence or infertility

Skeletal TB

Also called bone TB, skeletal TB affects most, if not, all of your bones, including your spine. The infection may spread  from the lungs and/or lymph nodes. Skeletal TB is more prevalent in countries with high HIV positive and AIDS cases as these tend to lower the body’s immunity.

Skeletal TB does not have any visible symptoms at first, but gradually, it causes bone deformities. Other signs include:

• Intense back pain
• Stiffness
• Growth of abscesses

Miliary TB

This form of extrapulmonary TB affects several organs at once. The infection may spread to the lungs, bone marrow, and liver, but can also infect the spine, brain, and heart.

The symptoms of miliary TB is similar to that of common TB symptoms. These include:

• Back pain
• Fatigue
• Swelling
• There may also be symptoms specific to the organs affected
• Weight loss
• Fever

Liver TB

Also known as hepatic TB, liver TB is a somewhat uncommon form of extrapulmonary tuberculosis which affects the liver. Besides the lungs, it may spread to the gastrointestinal tract, and lymph nodes.

Symptoms of liver TB include the following:

• High fever
• Upper abdominal pain
• Enlarged liver
• Jaundice or yellowish eyes

Gastrointestinal TB

Gastrointestinal TB infects most sections of the gastrointestinal tract, which includes various organs from the mouth, to the anus.

This extrapulmonary TB has signs that are similar to other gastrointestinal ailments or conditions. Other symptoms are:

• Abdominal pain
• Appetite and weight loss
• Recurring diarrhea
• Constipation
• Nausea

TB Meningitis

This form of extrapulmonary tuberculosis spreads and grows in the meninges, the tissue which surrounds the brain and spinal cord.

The lungs and the blood may spread the infection to the meninges. Unlike other types, the symptoms of TB meningitis may develop slowly.

Signs include:

• Back aches and muscle pain
• Tiredness
• Appetite loss
• Recurring headaches
• Fever
• Nausea

If TB meningitis progresses, it can also bring on:

• Severe headaches
• Light sensitivity
• Stiff neck

TB Peritonitis

TB peritonitis is a disease that infects peritoneum, the tissue lining the abdomen and the organs in that area.

Symptoms of TB peritonitis include:

• Fever
• Fluid collecting around abdomen
• Swelling and bloating due to trapped fluids
• Weakness
• Nausea
• Vomiting
• Loss of appetite

TB Pericarditis

This infection affects the pericardium, which consists of layers of tissue enveloping the heart to fix it in place.

Signs and symptoms of TB pericarditis include:

• Chest pain
• Fever
• Palpitations
• Shortness of breath
• Coughing

These symptoms may also be warning signs of a heart attack. Contact a doctor immediately in order to avoid further complications.

Cutaneous TB

Cutaneous TB is a rare extrapulmonary TB disease that affects the skin and may spread to other body parts. Though there are various types of this infection, the usual symptoms are sores that are:

• Painless
• Purple in color or reddish brown
• Wart-like
• Small and bumpy

These lesions may appear in the following areas:

• Around the elbows
• Hands
• Buttocks
• Skin behind the knees
• Feet

Extrapulmonary Tuberculosis Diagnosis

Doctors may perform a sputum smear, a common laboratory test performed for diagnosing all types of TB. The patient may also undergo molecular-based diagnostic tests.

Extrapulmonary Tuberculosis Treatment

Taking antibiotics is a common TB treatment. Depending on which part of the body is infected, treatment may last 6 to 9 months. For TB meningitis, it may last around 9 to 12 months. Patients may need corticosteroids for cases of pericarditis and meningitis, or when their body resists the drugs.

Surgery may be needed for:

• Draining abscesses and excess pericardium fluids
• Closing bronchopleural fistulas
• Surgically removing infected bowels
• Decreasing spinal cord encroachment

Learn more about Tuberculosis here.