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Extrapulmonary tuberculosis

Last reviewed: 9 Apr 2025
Last updated: 01 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • enlarged lymph node
  • pleuritic chest pain
  • skeletal pain
  • urinary symptoms
  • abdominal swelling
  • abdominal pain
  • headache
Full details

Other diagnostic factors

  • cough
  • altered mental status
  • neurologic symptoms
  • hepatomegaly
  • abnormal chest examination
  • fever
  • weight loss of more than 10% body weight
  • anorexia
  • malaise
  • night sweats
  • dyspnea
  • asymptomatic
  • erythema nodosum and erythema induratum
Full details

Risk factors

  • exposure to TB
  • born in Asia, Latin America, or Africa
  • HIV infection
  • immunosuppressive medications
  • hematologic or head/neck malignancy
  • end stage renal disease
  • apical fibrosis
  • intravenous drug use
  • female sex
  • Asian, black, and Native American ethnicity
  • malnutrition
  • alcoholism
  • diabetes
  • cirrhosis
  • high-risk congregate settings
  • low socioeconomic status
  • very young age
Full details

Diagnostic tests

1st tests to order

  • chest x-ray
  • sputum smear
  • sputum culture
  • CBC (complete blood count)
  • lymph node fine-needle aspiration
  • pleural fluid analysis
  • ascitic fluid analysis
  • bone films
  • cerebrospinal fluid analysis
  • urinalysis
  • nucleic acid amplification test (NAAT)
Full details

Tests to consider

  • lymph node biopsy
  • pleural biopsy
  • synovial biopsy
  • liver biopsy
  • bone marrow biopsy
  • blood culture
  • peritoneal biopsy
  • gastric aspirate
  • bronchoscopy
  • thoracoscopy
  • drug susceptibility testing
  • genotyping
  • HIV test
  • lateral flow urine lipoarabinomannan (LF-LAM) assay
  • empiric treatment
  • CT scan chest or abdomen
  • abdominal ultrasound
  • colonoscopy
  • pericardial fluid analysis
  • pericardial biopsy
  • tuberculin skin testing
  • interferon-gamma release assays
  • TB antigen-based skin tests (TBST)
Full details

Treatment algorithm

INITIAL

latent TB infection: nonpregnant

latent TB infection: pregnant

ACUTE

active TB: nonpregnant, HIV-negative

active TB: nonpregnant, HIV-positive

active TB: pregnant

Contributors

Authors

David J. Horne, MD, MPH
David J. Horne

Associate Professor

Division of Pulmonary, Critical Care, and Sleep Medicine

University of Washington

Seattle

WA

Disclosures

DJH declares that he has no competing interests.

Masahiro Narita, MD
Masahiro Narita

Professor of Medicine

Division of Pulmonary, Critical Care, and Sleep Medicine

University of Washington

Co-Founder

Firland Northwest TB Center

Seattle

WA

Disclosures

MN declares that he has no competing interests.

Peer reviewers

Carlos Acuña-Villaorduña, MD

Infectious Diseases Physician

Boston University Medical Center

Boston

MA

Disclosures

CA-V declares that he has no competing interests.

James Shepherd, MD, PhD

Infectious Disease Consultant

Yale University School of Medicine

New Haven

CT

Disclosures

JS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017 Jan 15;64(2):e1-33.Full text  Abstract

World Health Organization. WHO consolidated guidelines on tuberculosis: module 5: management of tuberculosis in children and adolescents. Sep 2022 [internet publication].Full text

Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016 Oct 1;63(7):e147-95.Full text  Abstract

National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. Mycobacterium tuberculosis infection and disease. May 2024 [internet publication].Full text

Nahid P, Mase SR, Migliori GB, et al. Treatment of drug-resistant tuberculosis. An official ATS/CDC/ERS/IDSA clinical practice guideline. Am J Respir Crit Care Med. 2019 Nov 15;200(10):e93-142.Full text  Abstract

World Health Organization. WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment. Module 1: prevention. 2020 [internet publication].Full text

World Health Organization. WHO consolidated guidelines on tuberculosis, module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Dec 2022 [internet publication]Full text  Abstract

British HIV Association. BHIVA guidelines for the management of tuberculosis in adults living with HIV 2018 (2023 interim update). 2023 [internet publication].Full text

World Health Organization. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. May 2022 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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    • WHO consolidated guidelines on tuberculosis: module 6: tuberculosis and comorbidities
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