Extrapulmonary Tuberculosis: Types, Symptoms, and Treatment of TB Meningitis

Extrapulmonary Tuberculosis: Types, Symptoms, and Treatment of TB Meningitis

Question. Describe various extra-pulmonary tuberculosis and how you treat a case of tubercular meningitis.
Answer.

Extrapulmonary Tuberculosis

In extrapulmonary tuberculosis, which involves all the major organs in the body, from the heart to the gastrointestinal tract.

The following are the various types of extrapulmonary tuberculosis:

Tuberculous Pericarditis

1. Involvement of pericardium is very common by M. tuberculum bacteria.
2. It occurs in form of pericarditis, pericardial effsion and later on there is constrictive pericarditis.
3. Its earliest sign is pericardial rub and fever.
4. As disease exacerbate, there is formation of effsion and when it is massive cardiac temponade may occur.

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Gastrointestinal tract

1. There is occurrence of primary lesion due to swallowing of tubercle bacilli which lodges in the ileocecal region and produce primary hypertrophic ileocecal tuberculosis.
2. Common manifestations are tuberculous peritonitis, tabes mesenterica, tuberculous enteritis, diarrhea and fitula.

Skeletal Tuberculosis

1. Tuberculosis of spine, paravertebral cold abscess, sinus tract formation and involvement of weight­bearing joints such as knees and hips.
2. When tubercular granuloma extend to the mandible or maxilla via extraction socket by means of hematological spread, this can lead to tuberculous osteomyelitis.
3. Early diagnosis by joint aspiration and biopsy is done to prevent disability and to avoid surgery.

Genitourinary Tuberculosis

1. It presents as painless hematuria and sterile pyuria.
2. In this renal parenchyma, calyces, ureter and bladder are affcted in descending order.
3. Testicular and epididymal involvement may be present which causes sterility.
4. In females Involvement of fallopian tubes causes female infertility.

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Meningeal tuberculosis

1. Tuberculoma in brain and tubercular meningitis are very
2. common complications and may leave behind number of sequelae.

Adrenal Tuberculosis

1. It produces the picture of Addison’s disease.
2. It is seen in long standing cases of abdominal tuberculosis.

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lupus vulgaris

When tubercle bacilli invade the skin this is known as lupus vulgaris.

Oral Tuberculosis

1. When tubercle bacilli directly inoculated in oral tissues of a person who had not acquired the immunity to the tuberculosis.
2. In oral cavity, there is involvement of tongue, gingiva, extraction socket and buccal mucosa.
3. In oral cavity at above mention sites, there is presence of typical tubercular ulcer.
4. Tuberculous gingivitis appears as diffse, hyperemic or nodular papillary proliferation.

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Treatment Of A Case Of Tubercular Meningitis

1. Antitubercular drugs: Rifampicin 600 mg/day + Isoniazide (600 to 900 mg/day) + Pyrazinamide (1.5 gm) should be given. Treatment with this regimen is given for 2 months.This is followed by rifampicin 600 mg/day + Isoniazide (600 to 900 mg/day) for 12 to 18 months.
2. Steroids: Prednisolone 40–60 mg/day to reduce toxicity, pia­arachnoid adhesions and feeling of well­being.