Extra-pulmonary TB: A dreaded disease that can affect any organ

4/18/2016 internal medicine

The mention of tuberculosis (TB) conjures up images of a wasted person with a persistent cough, sometimes with sputum which may be bloody, chest pains, weight loss and fever with night sweats. Whilst these are the typical symptoms of a person suffering from pulmonary (lung) TB, Dr Waweru Munyu, Pulmonologist at Aga Khan University Hospital sheds light on other manifestations of TB, particularly extra-pulmonary TB, which few Kenyans are aware of. While pulmonary TB accounts for about 70 percent of TB cases, extra pulmonary TB accounts for 20 to 30 percent. This type of TB can affect any organ including skin, eyes, brain, spine, bone, reproductive organs, intestines, and kidney, but most commonly affects the lymph glands. Dr Waweru explained, “We are always on the lookout for patients who come with symptoms that might appear not connected to pulmonary TB but have been persistent for a while. More often than not, these patients have received treatment, but their illness has not improved.” “For instance, a young woman was referred to my clinic. She had not had her monthly periods for a year but was not pregnant. The lady had also been suffering from fever and lower abdominal pains. She had visited a doctor who had prescribed antibiotics and painkillers for the abdominal pain and hormonal therapy for her periods.” “After taking her medical history, we did a biopsy which involved getting a tissue from the uterus and running tests on it. The biopsy confirmed that she had TB Endometritis which is TB of the uterus. We put her on a six month course of antimicrobial drugs which is the standard treatment for TB and she recovered.” “Another case involved a gentleman who presented with a neck ulcer that had been draining pus for many months. The wound was not healing despite taking antibiotics and getting regular dressing. We took a sample of the pus and sent it for TB analysis and it came out positive. He had been suffering from TB of the glands which is the most common extra-pulmonary TB.” “Spinal TB is a potentially debilitating form of extra pulmonary TB as it can lead to paralysis. Any persistent back pain accompanied by fever and weight loss should trigger an alarm for spinal TB. The investigations needed to detect this form of TB are MRI, CT or ultrasound scans, X-rays, fine needle aspiration, or bone biopsy.” In Kenya, treatment for any TB both pulmonary and extra-pulmonary is provided free by the government. This consists of a combination therapy of four drugs taken for two months and two drugs taken for four months. This six month treatment works for most cases of TB except for meningitis and bone TB which require more aggressive therapy which often takes at least nine months. Most people with TB are cured by strictly following a drug regimen that is provided to patients with support and supervision. Treatment of TB is sometimes complicated by resistance. This is a situation where the bacteria that causes TB does not respond to one or more of the drugs used in its treatment. Resistance is caused by inappropriate, or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (e.g. use of single drugs, poor quality medicines, or those kept in bad storage conditions) and premature treatment interruption. Detection is done using special laboratory tests which analyse the bacteria for sensitivity to the drugs, or detect resistance patterns. Resistance can vary from one drug (mono resistance) to two drugs or more (multi-drug resistance (MDR) of the most powerful anti-tubercular drugs available. XDR tuberculosis is when the TB is resistant to the above two drugs as well as a third group of injectable tuberculosis medication. This is an extremely difficult form to treat and most patients succumb to the disease. Drug resistant TB is a big concern in Kenya and the only solution to controlling it is making sure that the TB patient gets cured the first time round by providing access to diagnosis, having adequate infection control in facilities where patients are treated and ensuring the appropriate use of recommended second-line drugs. 90 per cent of patients diagnosed with ordinary TB will be treated successfully with proper adherence to drugs. The cost of treating normal TB is approximately seven thousand shillings in a private hospital, while the cost of treating drug resistant TB can run to millions of shillings per patient. It is therefore critical that all measures are taken to ensure that the dosage schedule is followed to avoid developing resistance to these drugs.

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Extra-pulmonary TB: A dreaded disease that can affect any organ

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