Extrapulmonary tuberculosis is a term that unites a whole group of diseases that affect different organ systems, ranging from skin and bones to the nervous system and lymph nodes. These pathologies are dangerous primarily because they are diagnosed too late, already at the stage of complications.
Naturally, many people are interested in detailed information about such diseases. Is extrapulmonary TB contagious? What organ systems can be affected by the infection? What symptoms accompany the disease? The answers to these questions will be useful to many readers.
Extrapulmonary tuberculous 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 an actively flowingpulmonary tuberculosis. However, occasionally, patients are diagnosed exclusively with extrapulmonary lesions.
If we talk about the infection of the human body, then in about 90% of the role of the causative agent is Mycobacterium tuberculosis (Koch's wand). 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, a different strain of the pathogen is common - M. africanum.
It should be said that these are extremely resistant microorganisms. In water, they are able to maintain the ability to live up to five months. In boiling water, mycobacteria survive 5-45 minutes. On the other hand, tuberculosis pathogens are extremely sensitive to ultraviolet radiation.
Can you get extrapulmonary TB?
Of course, tuberculosis of extrapulmonary localization, as well as the pulmonary form of the disease, is transmitted from a sick person to a he althy one. The pathogen is released into the environment along with mucus during coughing, sneezing, etc. Therefore, people who live and closely communicate with TB patients are at increased risk.
But it's not that simple. Many people, even after decades of living under the same roof with a 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 Koch's wand. However, not all of them actually suffer from tuberculosis.
Infection carriers are notcontagious and can live without even knowing they have an infection. However, there is a risk of developing the disease. Activation of mycobacteria occurs against the background of a strong decrease in immunity, therefore, risk factors include protracted diseases, chronic inflammatory diseases that simply deplete the body, as well as frequent stress, physical overstrain, hormonal disorders, malnutrition, in a word, everything that can affect the functioning of the immune system. system.
Classification and forms of the disease
There are several systems for classifying these pathologies. For example, the following extrapulmonary forms of tuberculosis are distinguished by prevalence:
- local - one focus is located in one affected organ (or segment, for example, the spine);
- common - several foci are located in the same organ;
- multiple lesion - they talk about it if tuberculosis affects several organs of the same system;
- Combined tuberculosis is diagnosed when there is damage to several organs from different systems (thus, the combination of "pulmonary / extrapulmonary tuberculosis" is possible).
During the diagnosis, attention is also paid to the degree of disease activity:
- active forms of the disease (progressive, recurrent, subsiding);
- inactive extrapulmonary forms of tuberculosis (the patient retains specific organ changes characteristic of tuberculosis, may havesmall lesions, abscesses or scarring, but laboratory tests show 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, systemic pathologies) and local (directly associated with the affected organ or system).
Tuberculosis of bones and joints
Extrapulmonary tuberculosis of the joints and bones is a relatively common chronic disease, which is accompanied by lesions of different parts of the musculoskeletal system. 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 naturally entails not only anatomical, but also functional changes in the skeleton.
According to statistics, most of the patients with this diagnosis are elderly people. In about 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 are almost non-existent in the early stages of the disease.
Sometimes patients report pain in the area of the affected part of the musculoskeletal system. If the disease develops according to the type of arthritis, then discomfort, swelling in small joints, limited movements can be noted. If we are talking about damage to the spine, then a growing granuloma often compressesnerve 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 such complications of extrapulmonary tuberculosis as abscesses, persistent skeletal deformities, fistulas are already present. Diagnosis of the disease can be associated with some difficulties, since the clinical picture here is very blurred. In most cases, even after well-conducted treatment, bone deformities remain.
Nervous system damage
Extrapulmonary tuberculosis of the meninges is considered the most severe form of the disease. The disease develops rapidly and, if left untreated, leads to irreversible disorders 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. The decrease in the spread of the disease is associated with the massive implementation of BCG vaccination among newborns. This theory is confirmed by the fact that today tuberculous meningitis is registered among children without vaccination.
Short-term headaches, mild fever, weakness and general malaise - this is how extrapulmonary tuberculosis begins. Symptoms appear as meningitis progresses. Headache comes on more often and gets worseintense. Body temperature rises to 39-40 degrees. Excitability increases, sensitivity to light develops. A characteristic sign is the appearance of anorexia and sudden weight loss. If left untreated, 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 account for only 2-3% of all cases of extrapulmonary tuberculosis. As a rule, at first the pathological process covers the lymph nodes of the retroperitoneal space and the mesentery, and only after that the tuberculosis lesions spread to the abdominal organs.
It is worth saying that sometimes the disease can pass to the esophagus. In such cases, there is a gradual ulceration of the walls of the esophageal tube, its narrowing up to complete stenosis. Approximately the same picture is observed in the defeat of the stomach - in the pyloric region and in the region of greater curvature, small, but multiple non-painful ulcers form.
Intestinal damage can spread to the tissues of the appendix. Sometimes patients are also 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.
To dangerous forms of tuberculosisrefers to mesadenitis. With such a disease, the lymphatic vessels of the peritoneum are affected, but the process gradually passes to the uterus and ovaries. Fibrous inflammation of the organs of the reproductive system causes infertility in patients.
Tuberculosis skin lesions
Koch's wand is often localized in the skin and subcutaneous tissues, causing a variety of diseases.
- Tuberculosis chancre - is a compacted formation, inside which purulent processes occur. As a rule, similar structures are formed in the region of the lymph node. Ulcers often open up, leaving behind fistulas.
- Tuberculosis lupus 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 characterized by the formation of a small dense knot on the skin, 1-3 cm in diameter. This is a painless tumor that opens with several fistulas.
- The warty form of skin tuberculosis is accompanied by the appearance of seals on the skin, which resemble papillomas in shape. Nevertheless, there are differences. In particular, there is an inflammatory rim around the formation, and the skin in this area becomes cyanotic. Most often, this form of the disease is diagnosed in patients with an open form of pulmonary tuberculosis, since sputum constantly gets on the skin during coughing. The risk group includesTB doctors and veterinarians.
- Miliary tuberculosis is accompanied by the appearance of small papular rashes of pink color. Often they are localized around natural openings, although their spread to other areas of the skin is not excluded. As the disease progresses, a small ulcer forms in the center of the papule, which then crusts over. If left untreated, the ulcerated areas become foci of necrosis.
Regardless of the form, cutaneous tuberculosis is characterized by a sluggish course without a pronounced inflammatory process or pain. Periods of remission are replaced by exacerbations, which, as a rule, fall in the spring and autumn.
Urogenital tuberculosis
If we are talking about such a disease 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 also spreads to the reproductive system, while among women, such cases are much less common.
The kidneys are the most commonly affected. The clinical picture is very indistinct. At first, there are no symptoms at all. As the disease progresses, mild, aching pain in the lower back may appear. Often, kidney tuberculosis is diagnosed by chance, during a complete urinalysis, detecting mycoplasma in samples.
If the patient is not given 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, men are primarily affectedprostate. Further complications develop in the form of infection of the testicles, vas deferens and spermatic cords.
Tuberculosis of the lymph nodes
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 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. The infection affects only one group of lymph nodes, and the cervical and submandibular ones are most often affected. Less often, the infection penetrates into the inguinal and axillary lymph nodes. In addition, generalized forms of the disease are also 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, there is an increase in lymph nodes. They are elastic, soft to the touch, mobile and initially painless. Changing their size has nothing to do with colds or diseases of the ENT organs.
A characteristic feature of the tuberculous form of lymphadenitis is the involvement in the pathological process of the surrounding soft tissues, and as the disease develops, the neighboring lymph nodes. This creates quite large swellings. In the future, a softening area appears in the center of the tumor. At this stage, the skin over the affected corners becomes thinner, sometimes becoming red or bluish.
If untreated, tissue rupture occurs, resulting in a fistula, through which the contents of the curdled consistency come out. The 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 - a relapse occurs, as a result of which the fistula reopens.
In some cases, there is a generalization of the pathological process, 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 obtained samples.
How to diagnose extrapulmonary TB?
As you can see, there are a huge number of symptoms and complications that lead to the development of extrapulmonary forms of tuberculosis. Diagnosis of such ailments, unfortunately, is fraught with some difficulties, since it is not possible to recognize the clinical picture in every case. Moreover, most patients are diagnosed at advanced stages of TB.
Naturally, to identify the disease, it is necessary to conduct a number of studies. First of all, this is the Mantoux test using different doses of tuberculin. This test helps determine if a patient is at risk. In addition, an important stage in the diagnosis is radiography and fluorography, since extrapulmonary forms of the disease, as a rule, develop against the background of pulmonary tuberculosis. Evenminor, residual lung lesions may confirm that the patient has infectious complications in various organs.
In the future, additional studies are being carried out, in particular, ultrasound, magnetic resonance 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, first of all, patients are 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, so these drugs are usually used as adjuvants.
Chemotherapy is considered the most effective. To date, there are several schemes for such treatment. The most commonly used so-called quadruple therapy, which includes the use of rifampicin, streptomycin, isoniazid and pyrazinamide. Some private clinics use a more progressive 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.
Because chemotherapytuberculosis has a negative effect on the body, various hepatoprotectors are used, as well as drugs that accelerate the process of removing toxins from the body (drugs containing acetylcysteine, rheosorbilact). In addition, an important part of therapy is the use of immunostimulants, including Glutoxim, Ximedon, Galavit.
Sometimes vitamins of group A are included in the treatment regimen in order to prevent the development of peripheral neuropathies. In some cases, surgery is necessary. In particular, surgery is prescribed in case of granuloma formation in the spine, as this is the only way to prevent serious damage to the nerve roots and spinal cord.
Even after all therapeutic measures have been taken, there are rules that the patient must follow. An important stage in the restoration of the body is a he althy lifestyle and 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.
