Extrapulmonary tuberculosis is a term by which a whole group of diseases that affect different organ systems, from the skin and bones to the nervous system and lymph nodes, is combined. 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 an infection infect? What are the symptoms of the disease? 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, as a rule, are secondary diseases and develop against the background of actively occurring pulmonary tuberculosis. Nevertheless, occasionally in patients exclusively extrapulmonary lesions are diagnosed.
If we talk about the infection of the human body, then approximately 90% of the pathogen is Mycobacterium tuberculosis ( Koch's bacillus ). Much less often, tuberculosis develops against the background of the introduction and active reproduction of Mycobacterium bovis - this bacterium, by the way, can also affect representatives of cattle. In tropical countries, another strain of the pathogen is common - M.africanum.
It is worth saying that these are extremely resistant microorganisms. In water, they are able to maintain the ability to live up to five months. Mycobacteria survive in boiling water for 5-45 minutes. Tuberculosis pathogens, on the other hand, are extremely sensitive to ultraviolet radiation.
Can I get extrapulmonary tuberculosis?
Of course, extrapulmonary localization tuberculosis, 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 along with mucus during coughing, sneezing, etc. Therefore, people in the high-risk group are those who live and communicate closely with patients with tuberculosis.
But it’s not so simple. Many people, even after more than a dozen years of life under the same roof as the patient, are not infected. Moreover, infection does not mean disease. It is believed that almost a third of the world's population are carriers of the Koch wand. Nevertheless, not all of them really suffer from tuberculosis.
Carriers of infection are not contagious and can live without even suspecting the presence of infection. Nevertheless, there is a risk of developing the disease. Mycobacteria activation occurs against the background of a strong decrease in immunity, therefore risk factors include protracted diseases, chronic inflammatory ailments that simply deplete the body, as well as frequent stresses, physical stress, hormonal disorders, malnutrition, in short, everything that can affect the functioning of the immune system 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 by prevalence:
- local - one lesion is located in one affected organ (or segment, if it is, for example, the spine);
- common - in the same body there are several foci;
- multiple lesion - it is said about if tuberculosis affects several organs of the same system;
- the diagnosis of combined tuberculosis is made if there is a lesion of several organs from different systems (thus, a combination of pulmonary / extrapulmonary tuberculosis is possible).
During the diagnosis, pay attention to the degree of activity of the disease:
- active forms of the disease (progressive, recurrent, subsiding);
- inactive extrapulmonary forms of tuberculosis (the patient retains specific organ changes characteristic of tuberculosis; small foci, abscesses, or scars may be present, but laboratory tests show that there are no further changes).
The presence of complications is also important for the diagnostic process. They can be general (for example, secondary immunodeficiency, toxic and allergic lesions of organs, amyloidosis, pathologies of systemic importance) and local (directly related to the affected organ or system).
Tuberculosis of bones and joints
Extrapulmonary tuberculosis of joints and bones is a relatively common chronic disease, which is accompanied by lesions of different parts of the motor apparatus. Against the background of the activity of pathogenic microorganisms, the formation of a specific granuloma is observed, as well as the progressive destruction of bone tissues, which, of course, entails not only anatomical, but also functional changes in the skeleton.
According to statistics, the majority of patients with this diagnosis are elderly people. In approximately 60% of cases, the disease affects the spine, which leads to disability. Gonitis, spondylitis and coxitis are the most common disorders that accompany extrapulmonary tuberculosis. Symptoms practically do not appear in the early stages of the disease.
Sometimes patients note pain in the affected part of the musculoskeletal system. If the disease develops as arthritis, then discomfort, swelling in small joints, and limited movements can be noted. If we are talking about damage to the spine, then a growing granuloma often squeezes the nerve roots, which is accompanied by various neurological disorders.
Signs include gradual changes in posture. Muscles begin to lose tone, making it difficult for a person to move.
Unfortunately, people go to the doctor in the later stages when complications of extrapulmonary tuberculosis such as abscesses, persistent skeletal deformities, fistulas are already present. Diagnosis of the disease can be fraught with some difficulties, since the clinical picture is very blurred. In most cases, even after correctly conducted treatment, bone deformities remain.
Nervous System Disorders
Extrapulmonary tuberculosis of the meninges is considered the most severe form of the disease. The disease develops rapidly and in the absence of treatment leads to irreversible disturbances in the functioning of the nervous system, and sometimes to death. True, to date, cases of this disease are rarely recorded.
At one time, such extrapulmonary tuberculosis was most often diagnosed in children. A decrease in the spread of the disease is associated with the mass BCG vaccination among newborns. This theory is confirmed by the fact that today tuberculous meningitis is registered among children without vaccination.
Short-term headache attacks, a slight fever, weakness and general malaise - this is how extrapulmonary tuberculosis begins. Symptoms appear as meningitis develops. Headache appears more often and becomes more intense. Body temperature rises to 39-40 degrees. Excitability increases, sensitivity to light develops. A characteristic feature is the appearance of anorexia and sudden weight loss. In the absence of treatment at 3-5 weeks, the patient dies, which is associated with paralysis of the respiratory or vasomotor center of the brain.
Abdominal tuberculosis
It is worth noting that abdominal lesions are rare and make up only 2-3% of all cases of extrapulmonary tuberculosis. As a rule, first the pathological process encompasses the lymph nodes of the retroperitoneal space and the mesentery, and only after that the tuberculous lesions spread to the abdominal organs.
It is worth saying that sometimes the ailment can pass to the esophagus. In such cases, there is a gradual ulceration of the walls of the esophagus tube, its narrowing up to complete stenosis. About the same picture is observed with lesions of the stomach - in the pyloric section and in the area of great curvature, small but multiple non-painful ulcers are formed.
Damage to the intestine can pass to the tissue of the appendix. Sometimes patients are diagnosed with tuberculosis of the small intestine. Unfortunately, the detection of extrapulmonary tuberculosis in this case is a difficult process. Symptoms of the disease are not too pronounced, and the clinical picture often resembles chronic enteritis, appendicitis and other diseases of the digestive system.
Dangerous forms of tuberculosis include mesadenitis. With such an ailment, the lymphatic vessels of the peritoneum are affected, but the process gradually passes to the uterus and ovaries. The fibrous inflammatory process of the organs of the reproductive system becomes the cause of infertility in patients.
Tuberculosis skin lesions
Koch's bacillus is often localized in the skin and subcutaneous tissues, causing a variety of diseases.
- Tuberculosis chancre - is a compacted formation, inside of which purulent processes occur. As a rule, similar structures form in the region of the lymph node. Abscesses are often opened, leaving fistulas behind themselves.
- Lupus erythematosus tuberculosis 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 with each other, forming a dense, flat infiltrate. Its shell is often covered with ulcers or fistulas.
- Collicative tuberculosis of the skin is an ailment that is characterized by the formation of a small dense knot on the skin, 1-3 cm in diameter. This is a painless tumor that is opened by several fistulas.
- The warty form of tuberculosis of the skin is accompanied by the appearance on the skin of seals that resemble papillomas in shape. Nevertheless, there are differences. In particular, there is an inflammatory rim around the formation, 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, because sputum constantly gets on the skin during coughing. The risk group includes doctors working with tuberculosis patients, as well as veterinarians.
- Miliary tuberculosis is accompanied by the appearance of small papular rashes of a pink color. Often they are localized around natural openings, although their spread to other parts 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, ulceration zones become foci of necrosis.
Regardless of the form, skin tuberculosis is characterized by a sluggish course without a pronounced inflammatory process or soreness. Periods of remission are followed by exacerbations, which, as a rule, occur in spring and autumn.
Urogenital tuberculosis
If we are talking about a disease such 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 spreads 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 vague. At first, the symptoms do not appear at all. As the disease develops, mild, aching lower back pain may appear. Often I diagnose kidney tuberculosis by chance, during a complete urinalysis, 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. Further complications develop in the form of infection of the testicles, vas deferens and spermatic cord.
Lymph node tuberculosis
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 varieties 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 tuberculous lymphadenitis are more often recorded. Infection affects only one group of lymph nodes, with cervical and submandibular lesions most often affected. Less commonly, the infection enters 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 at the same time.
Signs of extrapulmonary tuberculosis in this case are not too pronounced. In the initial stages, an increase in lymph nodes is observed. They are elastic, soft to the touch, mobile and initially painless. Change in their size is in no way associated with colds or diseases of ENT organs.
A characteristic sign of precisely the tuberculous form of lymphadenitis is the involvement in the pathological process of surrounding soft tissues, and as the disease develops, and neighboring lymph nodes. So quite large swelling is formed. Subsequently, a softening area appears in the center of the tumor. At this stage, the skin over the affected corners becomes thinner, sometimes acquiring a red or cyanotic shade.
In the absence of treatment, tissue rupture occurs, resulting in a fistula, through which the contents of the curdled consistency emerge. Tissues are covered with ulcers, bleeding is possible. The fistula can grow together, and rough scars form on its surface. Unfortunately, tissue healing does not last long - relapse occurs, as a result of which the fistula opens again.
In some cases, a 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 examination of the samples obtained.
How to diagnose extrapulmonary tuberculosis?
As you can see, there are a huge number of symptoms and complications that extrapulmonary forms of tuberculosis lead to. The diagnosis of such ailments, unfortunately, is associated with some difficulties, since far from every case is able to recognize the clinical picture. Moreover, most patients are diagnosed with advanced stages of tuberculosis.
Naturally, a number of studies are needed to identify the disease. First of all, this is a Mantoux test using different doses of tuberculin. This test helps determine if the patient is at risk. In addition, an important diagnostic step is radiography and fluorography, since extrapulmonary forms of the disease, as a rule, develop against the background of pulmonary tuberculosis. Even minor, residual lung lesions can confirm the patient's presence of infectious complications in various organs.
Further studies are conducted, in particular, ultrasound, magnetic resonance imaging and computed tomography, biopsy and laboratory examination of tissues for the presence of the causative agent of tuberculosis.
Treatment of extrapulmonary tuberculosis and its features
Of course, this is a dangerous diagnosis, and therefore, patients are primarily 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 treatment regimen for pulmonary forms of the disease.
Unfortunately, antibiotic therapy rarely works. The fact is that mycobacteria quickly develop resistance to almost all varieties of antibiotics, therefore, such drugs are usually used as adjuvants.
Chemotherapy is considered the most effective. To date, there are several schemes for such treatment. Most often, the so-called four-component therapy is carried out, which includes the use of rifampicin, streptomycin, isoniazid and pyrazinamide. Some private clinics use a more advanced five-component scheme, adding some new generation drugs to the list of drugs. The right combination helps to destroy the causative agents of tuberculosis, but, unfortunately, the treatment does not end there.
Since chemotherapy for tuberculosis negatively affects the body, various hepatoprotectors are used, as well as drugs that accelerate the elimination of toxins from the body (agents containing acetylcysteine, rheosorbilact). In addition, an important part of therapy is the administration of immunostimulants, including glutoxim, xymedon, galavit.
Sometimes vitamins of group A are included in the treatment regimen in order to prevent the development of peripheral neuropathies. In some cases, surgical intervention is necessary. In particular, surgery is prescribed if granulomas form 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 restoration of the body is a healthy lifestyle and a proper diet. The diet should include nutrients, as well as the whole complex of vitamins and minerals. It is important to restore normal body weight. And with tuberculosis (pulmonary or extrapulmonary), regular spa treatment is mandatory.