NEW DELHI: Early diagnosis of extrapulmonary tuberculosis (EPTB) in India is even more challenging than that of pulmonary TB owing to the nature of the disease which makes it difficult to identify and even culture the bacteria from different specimens, found a new research.
Authored by Surendra K Sharmaa, Alladi Mohand and Mikashmi Kohlie from Jamia Hamdard Institute of Molecular Medicine, AIIMS, Sri Venkateswara Institute of Medical Sciences and other institutes, the study noted that EPTB can develop during primary or post-primary TB.
“For a long time, with the global approach for TB control mainly focusing on pulmonary TB, the EPTB remained a largely neglected disease. Isolated occurrences of TB at body sites other than the lung have been termed EPTB,” the study stated.
As per the TB India Report 2020, EPTB accounted for 640,399 of the 2,404,815 (26.6 per cent) of all notified cases of TB. The notified EPTB cases in India have varied widely across states and regions. Among various forms of EPTB, two commonly encountered forms are peripheral lymph node TB followed by TB pleural effusion.
Disseminated TB and military TB are more frequently seen in immunosuppressed and HIV- seropositive individuals.
“EPTB can involve virtually any body site, except enamel, hair and nails. As the clinical presentation can be atypical, representative tissue samples for diagnostic testing are difficult to procure. The diagnosis of EPTB is often delayed or missed or made at advanced stages of the disease when complications have already set in or are developing. EPTB diagnosis must be reviewed and alternative diagnoses such as nocardia, nontuberculous mycobacterial (NTM) disease, fungal diseases, and malignancy must be ruled out during follow-up if the disease progresses or treatment response is not satisfactory,” the study mentioned.
Follow-up of EPTB patients is crucial as treatment is longer and requires monitoring of treatment adherence, and adverse events.
“In patients with EPTB, surgical intervention is frequently required to procure specimens for diagnostic testing. Sometimes, in addition to anti-TB treatment, surgery is required for the treatment of complications. A high index of clinical suspicion is essential to suspect EPTB. With judicious use of appropriate invasive diagnostic methods, early diagnosis of EPTB is now possible,” the study added.