Extra pulmonary tuberculosis: when tuberculosis bacteria invade other organs

Tuberculosis or TB is a disease caused by a bacterial infection Mycobacterium tuberculosis. Inflammation due to infection usually starts in the lungs, so this condition is often referred to as pulmonary TB. Some people just call it tuberculosis. However, in fact, infection M. tuberculosis can also spread to organs other than the lungs, such as the lymph nodes (lymph), bones, or intestines. This condition is known as extra pulmonary TB, or TB that occurs outside the lungs.

What is extra pulmonary TB?

Extra-pulmonary TB, or extrapulmonary TB, is a condition in which a bacterial infection occurs M. tuberculosis has spread to tissues and organs other than the lungs. Organs that can be infected with the bacteria that cause tuberculosis are the lymph glands, lining of the brain, joints, kidneys, bones, skin, and even genitals.

The signs and symptoms of extrapulmonary tuberculosis generally vary, depending on which organs are affected. Even so, the main characteristic that usually appears is the gradual decline in physical condition.

According to World Health Organization (WHO), about 20-25% of tuberculosis cases occur outside the lungs, so that it can be categorized as extra pulmonary TB. This type of TB can occur in patients of any age. Children and adults who have weak immune systems due to certain diseases, such as diabetes and HIV / AIDS are more at risk of developing extra pulmonary TB.

What are the types of extrapulmonary TB?

Here are the types of extrapulmonary TB, along with their symptoms:

1. Milier tuberculosis

Also known as generalized hematogenous TB, miliary TB occurs when a tuberculosis bacterial infection infects many organs in the body at one time. This spread usually occurs hematogenously, aka through blood.

This condition is usually found more frequently in patients with HIV, chronic kidney disease, have had organ transplant procedures, and are currently undergoing anti-TNF treatment to treat rheumatism.

The organs of the body that are usually affected by miliary tuberculosis are the liver, spleen, lymph nodes, lining of the brain, adrenal glands, and spinal cord.

2. Tuberculosis of lymph nodes

This type of extra-pulmonary TB is commonly found in certain countries in Asia and Africa. The groups most at risk of developing glandular tuberculosis are people with HIV / AIDS and children.

This condition is usually characterized by swollen lymph nodes in one or more parts of the body. Diagnosing lymph node TB is quite difficult, considering that swollen lymph nodes are also found in other health conditions or infections, such as leukemia, lymphoma, viral infections, toxoplasmosis, and syphilis.

3. Tuberculosis of bones and joints

Tuberculosis that occurs outside the lungs can also affect the bones and joints. Bone and joint tuberculosis commonly occurs in children. This may be caused by the condition of the bones and joints of the children who are still growing.

There are 3 types of tuberculosis in bones and joints, the most common, namely:

• Arthritis
  Arthritis caused by TB bacterial infection is usually a chronic monoarthritis. The joints commonly affected are the hip, knee, elbow and wrist.

• Osteitis
  Osteitis is inflammation that usually occurs in long bones, such as the legs. Sometimes, this condition arises due to arthritis that is not treated immediately.

• Spondylodicitis (spinal TB or Pott's disease)
  Extra-pulmonary TB found in the spine has the potential to cause damage and defects in the spine. If not handled properly, this condition can lead to paralysis.

4. Tuberculosis of the digestive tract

Bacteria M. tuberculosis can attack your digestive tract. However, apart from being caused by an active pulmonary TB infection, this condition can also occur when a patient is exposed to bacteria Mycobacterium bovis, or swallowing infected fluids M. tuberculosis.

The symptoms of this condition are quite difficult to distinguish from other health conditions, namely:

• Stomach ache
• Bloated
• Fatigue
• Fever
• Night sweats
• Weight loss
• Diarrhea
• Constipation
• Blood in stool

The most common complication due to inappropriate treatment of gastrointestinal TB is intestinal obstruction or blockage. People know this condition as intestinal TB.

5. Tuberculosis meningitis

Meningitis caused by tuberculosis is more common in children under 2 years of age and adults with HIV / AIDS.

Some of the signs and symptoms that commonly appear in meningitis-type extrapulmonary TB are:

• Headache
• Easy to get angry
• Fever
• Confusion
• Stiff neck
• Muscle weakness (hypotonia) in toddlers
• Photophobia (sensitive to light)
• Nausea and vomiting

TB meningitis is usually a dangerous health condition and must be treated immediately. If not treated properly, this disease has the risk of causing other neurological complications.

6. Tuberculosis pericarditis

TB infection that attacks the pericardium is called tuberculosis pericarditis. The pericardium is the membrane that covers your heart.

Slightly different from other extrapulmonary TB, tuberculosis pericarditis usually occurs after there is a bacterial infection M. tuberculosis in other organs. That is why, this condition is often associated with miliary TB.

If not treated immediately, TB pericarditis has the potential to lead to complications in the heart, such as constrictive pericarditis and cardiac tamponade.

7. Genital and urinary tuberculosis

Extra pulmonary TB can also occur in your genitals and urinary tract. Tuberculosis of the genitals is usually called genitourinary tuberculosis.

Some of the most common signs and symptoms are:

• Stomach ache
• Pain when urinating
• Urinating more frequently than usual, especially at night (nocturia)
• Pain in the back and ribs
• Swelling of the testicles
• There are red blood cells in the urine

8. Tuberculosis pleural effusion

Pleural effusion TB usually does not cause any symptoms, especially if the amount of fluid present in the pleura is less than 300 ml. The pleura is the lining of the lungs. However, if the buildup of fluid increases, the sufferer may experience symptoms of shortness of breath.

In addition, there are other symptoms that can appear, such as:

• Fever
• Weight loss drastically
• Night sweats
• Cough with phlegm

This type of extrapulmonary TB is more common in adults.

9. Tuberculosis of the skin

Tuberculosis bacterial infection can also enter the skin tissue and cause cutaneous tuberculosis or skin TB. Extra pulmonary TB has symptoms in the form of lesions that make the skin blister and swollen, also called chancre. It looks like a lump filled with pus.

These symptoms usually appear on the knees, elbows, hands, neck, and feet after 2-4 weeks of bacteria infecting the skin tissue. The severity of symptoms can vary from person to person depending on the condition of the immune system. Other symptoms of extrapulmonary TB affecting the skin are:

• Purple-brown rash around the skin lesions
• Pain in the skin lesions
• Erythema or a raised red rash on the skin
• The skin lesions last for years

What causes extra pulmonary TB?

Bacteria M. tuberculosis that is in the lungs can spread haematogenously or lymphatically. That is, bacteria can spread through the bloodstream or lymph vessels (lymph nodes) throughout the body.

However, infection can also directly attack certain organs, without the need to target the lungs first.

Risk factors for extrapulmonary TB infection include:

• Age of children or seniors
• Female
• Suffering from HIV / AIDS
• Chronic kidney disease
• Suffering from diabetes mellitus
• Have a bad immune system

How to treat extra pulmonary TB?

Extra-pulmonary TB is generally diagnosed using a chest x-ray, CT scan, MRI, or ultrasound. In addition, the medical team will also check for tuberculosis through body fluids (blood, urine, pleural fluid, pericardial fluid, or fluid in the joints) as well as a biopsy of possible infected body tissue.

Treatment for pulmonary and extrapulmonary TB is not much different. As with pulmonary TB, extra pulmonary TB can also be treated with anti-tuberculosis treatment.

There are also anti-TB treatment options to treat this disease. Several types of TB drugs that can be used are rifampicin, streptomycin, and kanamycin. However, this type of treatment must be in accordance with a doctor's prescription and rules, given the possibility of other health conditions that prevent you from taking anti-tuberculosis drugs carelessly.

If you have TB meningitis or pericarditis, your doctor will prescribe a corticosteroid medication, such as prednisolone, for the next few weeks along with your antibiotics. Using prednisolone can help reduce swelling in the infected area.

Surgical or surgical procedures are very rarely given to people with this condition. If the patient does have to undergo surgery, usually it is because extra pulmonary TB has resulted in organ damage and serious complications, such as hydrocephalus, obstruction of urine out of the kidneys, or constrictive pericarditis.