World TB (tuberculosis) Day on March 24 was started to create awareness among people about a chronic, sinister but totally curable disease. Before, T.B. was considered a death warrant. But the discovery of the first anti-TB. drug Streptomycin in 1943, kindled some hope in people, and other drugs followed subsequently. Today T.B. is curable with effective drugs, the only thing needed is timely diagnosis and treatment. In general, T.B. is considered a disease of the lungs. But it does affect other organs, what is known as extrapulmonary TB. Mycobacteria causing TB can spread from the primary site of infection to other organs, via the bloodstream, lymphatics, and even directly from adjacent organs. The lymphatic system is most commonly affected by TB which causes painless enlargement of lymph nodes. In early stages, it can affect the lymph nodes of the neck, but others can also be affected. Diagnosis is established via fine needle aspiration biopsy. Affection of the pleura (covering of the lungs) causes chest pain over the affected site while breathing in. One can also have night fever and sweats, loss of appetite, and weight with chronic cough. Untreated, over time infection can spread to another lung, causing further damage. If infection spreads to the heart, the outer covering of the heart (pericardium) is most commonly affected. Sometimes the middle layer (myocardium) or the aorta (a big blood vessel that carries blood from the heart to the body) may be affected. This manifests as breathlessness, palpitations, irregular heartbeat, and heart failure. Musculoskeletal T.B. mostly affects hips, knees or backbone. As such, any joint can be involved. The affected joint becomes stiff and painful. In case of inflammation, there is a firm to soft swelling over affected site (cold abscess). Involvement of the urinary system causes passing of blood in urine without any pain. Sterility can occur in both genders due to TB affecting the reproductive organs. In women, it can manifest as amenorrhea, i.e., absence of periods. Abdominal TB can affect the peritoneum (outer covering of abdominal parts), local lymph nodes or the intestines directly. Vague abdominal pain, abdominal distension, and altered bowel habits, are common manifestations. The brain or its coverings or spinal cord can be affected by T.B. This results in headache, vomiting without nausea, sudden loss of consciousness, paralysis of one or more limbs, etc., and neurological problems. Painless swelling can appear in the backbone over the affected site, deformity occurs due to the destruction of underlying vertebral bones. Though uncommon, T.B. can affect the eyes, as well as the skin. Signs are redness of the eyes, pain, blurred vision, light sensitivity, headache, flashes of light, and one or more of these symptoms, which vary in intensity. Skin effects manifest as ulcers, nodules, or rashes. Diagnosis of extrapulmonary tuberculosis becomes easy, if there is a history of pulmonary TB either in the past or currently. Otherwise, it needs a high index of suspicion, because extrapulmonary TB mimics several other diseases. For example, painless hematuria (passing of blood in urine) is a feature of bladder cancer as well. The typical constitutional symptoms of night fever and night sweats, loss of appetite, and loss of weight, may or may not occur. A complete blood picture test, showing a high lymphocyte count, raises suspicion of extrapulmonary TB. Demonstration of the causative mycobacteria in a fluid aspirate or biopsy confirms the diagnosis. The conventional six-month anti-TB treatment is started for extrapulmonary T.B. as well, after diagnosis. In conditions such as T.B. of meninges or brain or bone, treatment can be extended up to 9 to 12 months. Patients must be explained the necessity of completing the treatment for a prescribed duration. Otherwise, when one starts feeling good, they may stop the treatment. This enhances the risk for drug-resistant TB to evolve, where current drugs cease to be effective. Adverse effects of drugs developing in this duration are further deterrent to continue treatment. Permanent complications can set in such patients. Increasing awareness about extrapulmonary TB can help individuals seek timely treatment and get cured. Dr. Rachna Pande is a specialist in internal medicine.
