0:00
Hello, my name is Scott Heysell.
I'm an Associate
Professor of Medicine,
Infectious Diseases and
International Health
at the University of Virginia.
I'm also a Tuberculosis
Consultant for VDH.
I have the privilege to care
for people with TB here,
as well as with partners
abroad in TB endemic areas.
The topic today is
extrapulmonary tuberculosis,
a common manifestation of TB.
0:25
The outline for my talk begins with
a clinical case from rural Tanzania.
We'll talk briefly about
the pathophysiology of
extrapulmonary TB and then
delve into the epidemiology,
which is represented here in this
global burden of extrapulmonary TB.
We'll talk about some of
the reasons in which we see
some geographic differences
in extrapulmonary TB
but again, just how
common presentation of
extrapulmonary TB is in
relation to overall TB cases.
We'll talk about the
diagnostic considerations
and how that may differ in
conventional pulmonary TB,
and then dig into the
clinical presentations
including lymphadenitis,
osteoarticular TB,
gastrointestinal and
genitourinary manifestations,
as well as the morbid conditions
of TB meningitis and CNS TB.
Then I'll finish briefly with
therapeutic
considerations, again,
mostly the subtle
differences between
the treatment of pulmonary
TB and extrapulmonary TB.
1:28
Let's begin with a
representative case.
1:32
This is a 55 year-old man who's a
farmer living in rural Tanzania,
who presented to Haydom
Lutheran Hospital,
who had the good fortune
to care for him there.
He has been keeping cows
and goats for the most part
and has never really been to the
hospital throughout his life.
He does recall though that
he has family members
that have been treated
for TB in the past.
He has a wife and children
and they're all healthy,
but his main reason for presentation
is that he is incontinent of urine.
After further questioning,
it is found out that he has been
having night sweats for six months.
He is now walking hunched over
because of pain in his back
and changes in the way that his
spine has curved and changed,
and that has led to additional
numbness and weakness in his legs.
When you see him, he
is febrile but does
have pretty significant point
tenderness over his mid-back
and then presents with this obvious
gibbus deformity of the upper back.
