Extrapulmonary tuberculosis

Published on April 27, 2022   29 min

A selection of talks on Respiratory Diseases

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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.
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.
Let's begin with a representative case.
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.