Why is it in the News?

Approximately 20% of tuberculosis (TB) patients suffer from Extra-pulmonary TB, yet the majority remain undiagnosed. Even among those diagnosed, access to appropriate care is limited to specialized health facilities, posing a challenge to effective treatment.

What is Extra-pulmonary TB?

• Extra-pulmonary tuberculosis (EPTB) is a form of tuberculosis (TB) that affects organs outside the lungs, such as the lymph nodes, pleura, bones, joints, and central nervous system.
• EPTB accounts for a significant portion of active TB cases, ranging from 20% to 40%, and occurs more frequently in immunosuppressed individuals and young children.
• In HIV-positive individuals, EPTB is present in more than 50% of cases.
• EPTB diagnosis remains challenging due to the difficulty in accessing affected sites and the low sensitivity of diagnostic tests.
• A combination of mycobacteriology and histopathologic examinations, along with molecular techniques such as polymerase chain reaction, can aid in the diagnosis.
  • Biochemical markers, like adenosine deaminase or gamma interferon, can be useful adjuncts in diagnosing TB-affected serosal fluids.

Treatments:

• Treatment of EPTB typically involves standard anti-TB drug therapy, but the ideal regimen and duration have not yet been established.
• While the disease usually responds to treatment, complications and paradoxical responses may occur, necessitating the distinction from other causes of clinical deterioration.
• Surgery may be required to obtain diagnostic specimens or manage complications.

Challenges with EPTB:

• EPTB infections may leave disease markers lingering even after treatment, posing concerns about relapse.
• Standardized diagnosis and treatment protocols for various affected organs are lacking, complicating management.
• A lack of awareness among both patients and physicians, along with the absence of precise diagnostic and treatment criteria, adds to the challenge.
• Even after completing anti-TB therapy, some EPTB patients may experience lingering effects of the disease.
• The existing INDEX-TB guidelines, formulated over a decade ago, require updating to incorporate the latest insights and experiences.