CME-Antworten: Extrapulmonale Tuberkulose, Praxis Nr. 15

Abstract

CME: Extrapulmonary Tuberculosis Abstract. While tuberculosis mostly manifests as pulmonary infection, a dissemination in any extrapulmonary organ is possible. Extrapulmonary tuberculosis mostly affects lymph nodes, pleura and bones. Patients with immunosuppressive conditions such as an HIV co-infection or immunosuppressive therapies like TNF-alpha-inhibitors have a higher risk of a dissemination of tuberculosis. Diagnosis of extrapulmonary tuberculosis is difficult, as microbiological testing mostly requires invasive procedures to obtain a sample for direct proof of tuberculosis by microscopy, culture, molecular methods (e.g. Xpert(R) MTB/RIF) or histology. Treatment follows guidelines of pulmonary tuberculosis with a two-month regimen consisting of four drugs (rifampicin, isoniazide, pyrazinamide and ethambuthol), followed by a four-month therapy with two drugs (rifampicin and isoniazide). Duration of therapy is extended in tuberculous meningitis to one year and in a skeletal dissemination up to six to nine months. Corticosteroids are recommended in cerebral and pericardial tuberculosis.