Extrapulmonary tuberculosis

Last reviewed: 7 Sep 2022
Last updated: 30 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • enlarged lymph node
  • pleuritic chest pain
  • skeletal pain
  • urinary symptoms
  • abdominal swelling
  • abdominal pain
  • headache
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • sputum smear
  • sputum culture
  • tuberculin skin testing
  • 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)
More 1st investigations to order

Investigations 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
  • interferon-gamma release assays
  • 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
More investigations to consider

Treatment algorithm

INITIAL

latent TB infection: nonpregnant

latent TB infection: pregnant

ACUTE

no comorbidity nonpregnant, presumed or confirmed active TB: induction phase

with comorbidity nonpregnant, presumed or confirmed active TB: induction phase

pregnant, presumed or confirmed active TB: induction phase

ONGOING

no comorbidity nonpregnant: continuation phase

with comorbidity nonpregnant: continuation phase

pregnant: continuation phase

Contributors

Authors

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

Associate Professor

Division of Pulmonary, Critical Care, and Sleep Medicine

University of Washington

Director

Firland Northwest TB Center

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

Ali Hassoun, MD, FACP, FIDSA, AAHIVS

Infectious Disease Specialist

Alabama Infectious Diseases Center

Huntsville

AL

Disclosures

AH declares that he has no competing interests.

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