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TUBERCULOSIS
HamidReza Naderi MD
Department of Infectious Diseases
Mashhad University of Medical Sciences
Extrapulmonary tuberculous
disease occurs as result of
contiguous spread of tubercle
organisms to adjoining
structures, such as pleura or
pericardium, or by
lymphohaematogenous spread
during primary or chronic
infection.
According to the World Health
Organization (WHO) patients
who are sputum smear-positive
Lymphadenitis
Tuberculous lymphadenitis (scrofula) is
the most common form of
extrapulmonary TB.
The diagnosis of scrofula usually is
made by fine needle aspiration of an
affected lymph node. Although AFB
smears are positive in only
approximately 20% of cases,
granulomatous inflammation may be
obvious.
Overall, fine needle aspiration has a
sensitivity of 77% and specificity of
Pleural Effusion
Pleural extrapulmonary TB may
occur early after primary infection
with MTB and manifest as pleurisy
with effusion, or more rarely, it
may occur late in postprimary
cavitary disease and arise as an
empyema.
Tuberculous pleural involvement
often causes no symptoms and
resolves spontaneously; however,
in untreated patients, a 65%
relapse rate has been reported,
Gastrointestinal Disease
Gastrointestinal TB infection usually
is secondary to hematogenous or
lymphatic spread but also may result
from swallowed bronchial secretions
or direct spread from local sites, such
as lymph nodes or fallopian tubes.
TB may occur in any gastrointestinal
location from the mouth to the anus,
but lesions proximal to the terminal
ileum are rare.
The ileocecal area is the most
common site of involvement,
producing signs and symptoms of
Peritonitis
Tuberculous peritonitis may develop
from local spread of MTB infection
from a tuberculous lymph node,
intestinal focus, or infected fallopian
tube.
In addition, peritonitis can develop
from seeding of the peritoneum in
miliary TB or from the reactivation of
a latent focus.
The patient commonly has pain and
abdominal swelling associated with
fever, anorexia, and weight loss.