Steps in Diagnosing Extra-Pulmonary TB (EPTB)

EPTB Site Pleural Presentation Effusion is usually unilateral of modest scale; cough, fever, pleuritic chest pain, dyspnea, chills, weight loss, malaise Painless enlargement of nodes of posterior cervical and supraclavicular group Sterile pyuria; haematuria; frequency; dysuria; flank pain. May also be asymptomatic Mass lesion of the testis or epididymis in men Infertility, pelvic pain and menstrual disturbances in women Presentations are diverse. Systemic symptoms may include fever, weakness, anorexia, and weight loss Pain over localized area. Children/adolescents-often thoracic vertebrae. Adultsfrequently lumbar vertebrae Symptoms may include malaise, headache, anorexia, nausea. Cerebrospinal fluid (CSF) is often clear and pressure normal Hemodynamically significant pericardial effusion, often with pleural effusions and intrathoracic lymphadenopathy. Can result in constrictive pericarditis Diagnostics Culture of pleural fluid (although yield is low); effusions are usually lymphocytic exudates Excisional biopsy or fine needle aspiration (FNA) for AFB smear and culture Urine for TB culture (3-5 first morning urine samples); IV pyelogram Tissue from affected site for AFB smear/culture Mass lesions are to be biopsied for both histology and culture Chest radiography; tissue or fluid from affected site for AFB smear/culture Spinal imaging; FNA of vertebral lesions and/or paraspinous abscesses when feasible CSF glucose levels are lower than serum glucose levels with an increase in cells & protein Echocardiogram; chest ultrasound to measure and identify pericardial effusion; pericardiocentesis, and pericardial biopsy; routine TB workup

Lymphatic

Renal

Genital

Disseminated

Spine

Central Nervous System

Pericardial

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Steps in Diagnosing Extra-Pulmonary TB (EPTB)

International Standard for Tb Care #3

For all patients (adults, adolescents, and children) suspected of having extrapulmonary tuberculosis, appropriate specimens from the suspected sites of involvement should be obtained for microscopy and, where facilities and resources are available, for culture and histopathological examination.

1. Medical History  For TB evaluation, the patient history should include: n  Known exposure to a person who has infectious TB? n Symptoms of TB disease and date of onset? n  Previous treatment for TB infection or TB disease? n Risk factors for developing the disease? n  HIV and other medical conditions that might impact treatment? 2.  Bacteriologic Examination (AFB smear & culture) Initial smear-negative sputum specimens obtained from a patient with clinically diagnosed EPTB should be sent for TB culture. Other specimens that may be sent for AFB smear/culture or histopathological examination might include: n Bronchoalveolar lavage n  Aspirated fluid from pleura, stomach, or other site n  Biopsied tissue from lung, peripheral lymph node, or other site where TB is suspected n Blood or urine 3. Drug Susceptibility Testing (DST) n All initial positive TB cultures n  Positive cultures from patients who are failing treatment, defaulters, or who have relapsed
Source:  Interim Caribbean Guidelines for the Prevention, Treatment, Care, and Control of Tuberculosis, 2008. 9/08