Abstract
Pathogenic Mycobacterium tuberculosis complex organisms (MTBC) primarily cause pulmonary tuberculosis (PTB); however, MTBC are also capable of causing disease in extrapulmonary (EP) organs, which pose a significant threat to human health worldwide. Extrapulmonary tuberculosis (EPTB) accounts for about 20–30% of all active TB cases and affects mainly children and adults with compromised immune systems. EPTB can occur through hematogenous, lymphatic, or localized bacillary dissemination from a primary source, such as PTB, and affects the brain, eye, mouth, tongue, lymph nodes of neck, spine, bones, muscles, skin, pleura, pericardium, gastrointestinal, peritoneum, and the genitourinary system as primary and/or disseminated disease. EPTB diagnosis involves clinical, radiological, microbiological, histopathological, biochemical/immunological, and molecular methods. However, only culture and molecular techniques are considered confirmatory to differentiate MTBC from any non-tuberculous mycobacteria (NTM) species. While EPTB due to MTBC responds to first-line anti-TB drugs (ATD), drug susceptibility profiling is an essential criterion for addressing drug-resistant EPTB cases (DR-EPTB). Besides antibiotics, adjuvant therapy with corticosteroids has also been used to treat specific EPTB cases. Occasionally, surgical intervention is recommended, mainly when organ damage is debilitating to the patient. Recent epidemiological studies show a striking increase in DR-EPTB cases ranging from 10–15% across various reports. As a neglected disease, significant developments in rapid and accurate diagnosis and better therapeutic interventions are urgently needed to control the emerging EPTB situation globally. In this review, we discuss the recent advances in the clinical diagnosis, treatment, and drug resistance of EPTB.
Highlights
Tuberculosis (TB) is a significant cause of morbidity and mortality among humans worldwide
We summarize the recent developments in the diagnosis and treatment of extrapulmonary tuberculosis (EPTB) with a particular emphasis on the rising surge of drug-resistant forms of EPTB cases
Specific symptoms are observed depending on the organ involved and usually show cutaneous lesions (Tuberculosis cutis miliaris disseminate), choroidal tubercles, and commonly TB
Summary
Tuberculosis (TB) is a significant cause of morbidity and mortality among humans worldwide. Common disease manifestations of EPTB include meningitis, lymphadenitis, ocular, oral, pleuritis, pericarditis, peritonitis, cutaneous, musculoskeletal, abdominal, genitourinary, and miliary forms of tuberculosis (Table 1). Most cases show constitutive symptoms such as fever, weight loss, night sweats, or malaise with specific systemic symptoms based on the organ affected. Pericarditis presents as fever, weight loss, night sweats, cough, chest pain, and breathlessness, along with moderate to high pericardial effusion. Urinary tract involvement with fever, weight loss, and sweating are observed along with urologic symptoms such as flank pain, pyuria, hematuria, and even urinary incontinence. Specific symptoms are observed depending on the organ involved and usually show cutaneous lesions (Tuberculosis cutis miliaris disseminate), choroidal tubercles, and commonly TB meningitis; atypical manifestations are seen. Note: All EPTB conditions listed in the table can occur as primary (rare) or secondary (common) infections, with some showing differential clinical presentation
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