Non-pulmonary mycobacterial infection

Abstract

<h2>Abstract</h2> Although worldwide pulmonary disease remains the most important public health manifestation of tuberculosis (TB), non-pulmonary TB and non-tuberculous mycobacterial disease are of increasing clinical significance. This is partly because of increasing HIV co-infection. One-third of UK TB notifications are extrapulmonary; the proportions vary with ethnicity. This contribution discusses the epidemiology, clinical features and diagnosis of TB in the CNS, lymph nodes, pleura, pericardium, skeleton and skin. Lymph node TB is the most common non-pulmonary type, though TB meningitis arguably has the greatest consequences. Non-pulmonary TB is harder to diagnose and requires radiography, CT and MRI as appropriate; the taking of appropriate specimens is mandatory (fine-needle aspirates, excision biopsies (e.g. lymph nodes) without formalin, sufficient CSF (for TB meningitis) for microscopy, culture on solid and liquid media, molecular DNA/RNA amplification techniques, histopathological examination). A detailed examination for pulmonary disease is always worthwhile, because it often coexists with non-pulmonary disease. Treatment for drug-sensitive TB uses standardized combination chemotherapy for 6 months (up to 9 months in skeletal TB, 12 months in TB meningitis), with adjunct corticosteroid treatment in TB meningitis, pleuritis, pericarditis, ureteric disease and paradoxical lymph node enlargement. Surgery has a limited role in the treatment of TB (taking of biopsies, treating pericardial tamponade, spinal decompression and management of spinal deformities, shunt placement for hydrocephalus); node excision is useful in the treatment of some cases of non-tuberculous lymphadenopathy.