Extrapulmonary tuberculosis: causes, symptoms and treatment

Extrapulmonary tuberculosis is a term that unites a whole group of diseases affecting various systems of organs, from the skin and bones to the nervous system and lymph nodes. These pathologies are dangerous primarily because they are diagnosed too late, already at the stage of development of complications.

Naturally, many people are interested in detailed information about such diseases. Is extrapulmonary tuberculosis contagious? What organ systems can affect the infection? What symptoms are accompanied by ailment? Answers to these questions will be useful to many readers.

Extrapulmonary tuberculosis lesions and their causes

Extrapulmonary tuberculosis is an infectious disease associated with the penetration of mycobacteria into the human body. They can affect various organ systems, including the skeleton, intestines, stomach, skin, eyes, kidneys, etc. According to statistical studies, extrapulmonary forms are usually secondary diseases and develop against the background of active pulmonary tuberculosis. Nevertheless, occasionally, only extrapulmonary lesions are diagnosed in patients.

If we talk about the infection of the human body, then approximately 90% of the causative agent is Mycobacterium tuberculosis (Koch's stick). Much less often tuberculosis develops against the background of the introduction and active reproduction of Mycobacterium bovis - this bacterium, by the way, can affect representatives of cattle. In the tropical countries, a different strain of the pathogen, M.africanum, is common.

It is worth saying that these are extremely resistant microorganisms. In water, they are able to maintain their ability to live up to five months. In boiling water, mycobacteria survive 5-45 minutes. On the other hand, the pathogens of tuberculosis are extremely sensitive to ultraviolet radiation.

Can I get extrapulmonary tuberculosis?

Certainly, the tuberculosis of extrapulmonary localization, as well as the pulmonary form of the disease, is transmitted from a sick person to a healthy one. The causative agent is excreted into the external environment together with mucus during coughing, sneezing, etc. Therefore, in a group of increased danger there are people who live and closely communicate with patients with tuberculosis.

But it's not so simple. Many people, even after not one decade of life under one roof with the patient, are not infected. Moreover, infection does not mean disease. It is believed that almost a third of the world's population - carriers of the stick Koch. Nevertheless, not all of them really suffer from tuberculosis.

The carriers of the infection are not contagious and can live without even knowing of the presence of infection. Nevertheless, there is a risk of developing the disease. Activation of mycobacteria occurs against a background of a strong decrease in immunity, so the risk factors include protracted diseases, chronic inflammatory diseases that simply deplete the body, as well as frequent stresses, physical overstrain, hormonal disorders, malnutrition, in short, anything that could affect the immune function System.

Classification and forms of the disease

There are several classification systems for these pathologies. For example, the following extrapulmonary forms of tuberculosis are distinguished:

• Local - one focus is located in one affected organ (or segment, if it comes, for example, about the spine);
• Common - in one and the same organ there are several foci;
• Multiple lesions - they speak of it in the event that tuberculosis affects several organs of the same system;
• The diagnosis of "co-infected tuberculosis" is set when several organs from different systems are affected (thus, the combination of "pulmonary / extrapulmonary tuberculosis" is possible).

During the diagnosis, attention is paid to the degree of activity of the disease:

• Active forms of the disease (progressive, recurrent, fading);
• Inactive extrapulmonary forms of tuberculosis (the patient retains specific organ changes characteristic of tuberculosis, there may be small foci, abscesses or scarring, but laboratory tests show no further changes).

The presence of complications is important for the diagnosis process. They can be common (for example, secondary immunodeficiency, toxic and allergic organ damage, amyloidosis, systemic pathology) and local (directly related to the affected organ or system).

Tuberculosis of bones and joints

Extrapulmonary tuberculosis of the joints and bones is a relatively common chronic disease, which is accompanied by lesions of different parts of the motor apparatus. Against the backdrop of the activity of pathogenic microorganisms, the formation of a specific granuloma is observed, as well as the progressive destruction of bone tissues, which naturally entails not only anatomical but also functional changes in the skeleton.

According to statistics, most patients with this diagnosis are elderly people. Approximately 60% of cases affect the spine, which leads to disability. Gonites, spondylitis and coxites are the most common disorders that accompany extrapulmonary tuberculosis. Symptoms are almost not manifested in the early stages of the disease.

Sometimes patients note soreness in the area of the affected part of the musculoskeletal system. If the disease develops according to the type of arthritis, then one can note discomfort, swelling in small joints, limited movements. If we are talking about the defeat of the spine, then the growing granuloma often squeezes the nerve roots, which is accompanied by various neurological disorders.

Signs include gradual changes in posture. Muscles begin to lose tonus, which makes it difficult for a person to move.

Unfortunately, people turn to the doctor in the late stages, when there are already complications of extrapulmonary tuberculosis, such as abscesses, persistent skeletal deformities, fistulas. Diagnosis of the disease may be associated with some difficulties, since the clinical picture here is very blurred. In most cases, even after a properly performed treatment, deformities of the bones remain.

Disorders of the nervous system

Extrapulmonary tuberculosis of meninges is considered to be the most severe form of the disease. The illness develops rapidly and, in the absence of treatment, leads to irreversible disturbances in the work of the nervous system, and sometimes to death. However, to date, cases of this disease are rarely recorded.

At one time, such extrapulmonary tuberculosis in children was most often diagnosed. Reducing the spread of the disease is associated with a massive inoculation of BCG vaccination among newborns. This theory is confirmed by the fact that tuberculous meningitis is currently registered among children without vaccination.

Short-term headache attacks, a slight increase in temperature, weakness and general malaise - this is how extrapulmonary tuberculosis begins. Symptoms appear as the development of meningitis. The headache appears more often and becomes more intense. Body temperature rises to 39-40 degrees. Increases excitability, developing sensitivity to light. A characteristic feature is the appearance of anorexia and a sharp weight loss. In the absence of treatment at 3-5 weeks, the patient's death occurs, which is associated with paralysis of the respiratory or vasomotor center of the brain.

Abdominal tuberculosis

It should be noted that abdominal lesions are rare and account for only 2-3% of all cases of extrapulmonary tuberculosis. As a rule, first the pathological process covers the lymph nodes of the retroperitoneal space and the mesentery and only after that the tuberculosis lesions spread to the organs of the abdominal cavity.

It is worth saying that sometimes an ailment can pass to the esophagus. In such cases, there is a gradual ulceration of the esophageal tube walls, its narrowing down to complete stenosis. Approximately the same pattern is observed in the defeat of the stomach - in the pyloric section and in the region of great curvature, small but multiple non-ulcerative ulcers are formed.

Lesion of the intestine can pass to the tissue of the appendix. Sometimes patients are diagnosed and tuberculosis of the small intestine. Unfortunately, the detection of extrapulmonary tuberculosis in this case is a difficult process. Symptoms of the disease are not very pronounced, and the clinical picture often resembles chronic enteritis, appendicitis and other diseases of the digestive system.

Dangerous forms of tuberculosis include mesadenitis. With a similar ailment the lymph vessels of the peritoneum are affected, but the process gradually passes to the uterus and the ovaries. Fibrous inflammatory process of the organs of the reproductive system causes infertility in patients.

Tuberculous skin lesions

Koch's rods are often localized in the skin and subcutaneous tissues, causing a variety of diseases.

• Tuberculosis chancre - is a compacted formation, inside which purulent processes occur. As a rule, similar structures are formed in the region of the lymph node. Ulcers are often opened, leaving behind fistulas.
• Tuberculosis lupus is a disease that is characterized by the appearance of a specific rash on the skin of the face. Rashes are dense nodules that gradually merge, forming a dense, flat infiltrate. The shell is often covered with ulcers or fistulas.
• Collicative tuberculosis of the skin is a malaise, which is characterized by the formation on the skin of a small dense junction, 1-3 cm in diameter. It is a painless tumor that is opened by several fistulas.
• A warty form of skin tuberculosis is accompanied by the appearance of seals on the skin that resemble papillomas in shape. Nevertheless, there are differences. In particular, around the formation there is an inflammatory rim, and the skin in this zone acquires a cyanotic hue. Most often, this form of the disease is diagnosed in patients with an open form of pulmonary tuberculosis, since sputum constantly enters the skin during a cough. The risk group includes doctors working with tuberculosis patients, as well as veterinarians.
• Miliary tuberculosis is accompanied by the appearance of small papular eruptions of pink color. Often they are localized around natural openings, although their spread to other areas of the skin is not excluded. As the disease progresses, a small ulcer forms in the center of the papule, which is then covered with a crust. In the absence of treatment, the zones of ulceration become necrosis foci.

Regardless of the form, cutaneous tuberculosis is characterized by a sluggish course without pronounced inflammatory process or soreness. The periods of remission are replaced by exacerbations, which, as a rule, fall on spring and autumn time.

Urogenital tuberculosis

If it is a case of such a disease as extrapulmonary tuberculosis, then in about 37% of cases the infection affects the organs of the excretory system. According to statistics, in men the infection extends to the reproductive system, while among women such cases are much less common.

Most often, the kidneys suffer from the disease. The clinical picture is very fuzzy. At first, the symptoms do not appear at all. As the disease develops, mild, aching pains in the lower back may appear. Often, kidney tuberculosis is diagnosed accidentally, during a complete urine test, detecting mycoplasma in the samples.

If you do not provide the patient with the necessary medical care, there is a risk of developing fibrosis and hydronephrosis.

In cases where the infection spreads to the organs of the reproductive system, in men the prostate gland is primarily affected. Then complications develop in the form of infection of the testicles, vas deferens and spermatic cord.

Tuberculosis of the lymph nodes

The most common form is extracellular tuberculosis, which affects the peripheral lymph nodes. According to statistics, it accounts for about 50% of all cases of extracellular forms of the disease. Moreover, as a rule, it is combined with damage to the lungs and other organs of the chest.

In modern medicine, cases of local tuberculosis lymphadenitis are more often reported. Infection affects only one group of lymph nodes, and most often suffer cervical and submandibular. Less often the infection penetrates into the inguinal and axillary lymph nodes. In addition, generalized forms of the disease are possible, in which more than three groups of lymph nodes are affected simultaneously.

Signs of extrapulmonary tuberculosis in this case are not very pronounced. At the initial stages, there is an increase in lymph nodes. They are elastic, soft to the touch, mobile and initially painless. The change in their size is not related to colds or diseases of ENT organs.

A characteristic feature of the tuberculous form of lymphadenitis is the involvement in the pathological process of surrounding soft tissues, and as the disease progresses - and the neighboring lymph nodes. Thus, rather large swelling forms. Later on, a softening site appears in the center of the tumor. At this stage, the skin over the amazed corners is thinned, sometimes acquires a red or cyanotic tint.

In the absence of treatment, a tissue rupture occurs, resulting in a fistula, through which the contents of the curdiness enter the outside. The tissues are covered with ulcers, bleeding is possible. The fistula can coalesce, and on its surface rough scars are formed. Unfortunately, tissue healing does not last long - a relapse occurs, as a result of which the fistula opens again.

In some cases generalization of the pathological process is observed, other groups of lymph nodes are affected. Extrapulmonary tuberculosis leads to such dangerous consequences. Diagnosis in this case is carried out by biopsy with further laboratory testing of the samples.

How is extrapulmonary tuberculosis diagnosed?

As can be seen, there are a huge number of symptoms and complications, to the development of which extrapulmonary forms of tuberculosis are caused. Diagnosis of such ailments, unfortunately, involves some difficulties, since it is not possible to recognize the clinical picture in every case. Moreover, most patients are diagnosed already in advanced stages of tuberculosis.

Naturally, a number of studies are needed to identify the disease. First of all, this is a Mantoux test with different doses of tuberculin. This test helps determine if the patient is at risk. In addition, an important stage of diagnosis is radiography and fluorography, since extrapulmonary forms of the disease tend to develop against the background of pulmonary tuberculosis. Even minor, residual lung lesions can confirm the presence of the patient's infectious complications in certain organs.

In the future, additional studies are carried out, in particular, ultrasound, magnetic resonance and computed tomography, biopsy and laboratory examination of tissues for the presence of a causative agent of tuberculosis.

Treatment of extrapulmonary tuberculosis and its features

Of course, this is a dangerous diagnosis, and therefore, in the first place, patients are interested in the availability of effective therapeutic procedures. Treatment of extrapulmonary tuberculosis is a long and complex process, and its main stages coincide with the therapy scheme for pulmonary forms of the disease.

Unfortunately, antibiotic therapy works rarely. The fact is that mycobacteria quickly develop resistance to almost all varieties of antibiotics, so these drugs are usually used as an auxiliary.

The most effective is chemotherapy. To date, there are several schemes of such treatment. Most often, the so-called four-component therapy, which includes the use of rifampicin, streptomycin, isoniazid and pyrazinamide. Some private clinics use a more progressive five-component scheme, adding to the list of drugs some new generation drugs. Correctly selected combination helps to destroy the pathogens of tuberculosis, but, unfortunately, the treatment does not end there.

Since chemotherapy for tuberculosis adversely affects the body, various hepatoprotectors are used, as well as drugs that accelerate the process of removing toxins from the body (agents containing acetylcysteine, rheosorbylact). In addition, an important part of therapy is the use of immunostimulants, including glutoxim, xymedon, galavite.

Sometimes the treatment regimen includes group A vitamins to prevent the development of peripheral neuropathies. In some cases, surgical intervention is necessary. In particular, the operation is prescribed in the case of the formation of granulomas in the spine, since this is the only way to prevent serious damage to the nerve roots and spinal cord.

Even after carrying out all therapeutic measures, there are rules by which the patient should be guided. An important stage in the recovery of the body is a healthy lifestyle and a proper diet. The diet should include nutrients, as well as the entire complex of vitamins and minerals. It is important to restore normal body weight. And even with tuberculosis (pulmonary or extrapulmonary), regular sanatorium-and-spa treatment is mandatory.