Extrapulmonary TB

 Two additional resources on extrapulomary TB

Core Curriculum on Tuberculosis: What the Clinician Should Know

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Extrapulmonary

Extrapulmonary TB disease occurs in places other than the lungs, including the larynx, the lymph nodes, the pleura, the brain, the kidneys, or the bones and joints. In HIV-infected persons, extrapulmonary TB disease is often accompanied by pulmonary TB. Persons with extrapulmonary TB disease usually are not infectious unless they have 1) pulmonary disease in addition to Chapter 2: Transmission and Pathogenesis of Tuberculosis 31 extrapulmonary disease; 2) extrapulmonary disease located in the oral cavity or the larynx; or 3) extrapulmonary disease that includes an open abscess or lesion in which the concentration of organisms is high, especially if drainage from the abscess or lesion is extensive, or if drainage fluid is aerosolized. Persons with TB pleural effusions may have underlying pulmonary TB that is masked on chest radiograph because the effusion fluid compresses the lung. These patients should be considered infectious until pulmonary TB disease is excluded.

Chapter 7, page 192:

The infectiousness of a TB patient is directly related to the number of droplet nuclei carrying M. tuberculosis (tubercle bacilli) that are expelled into the air. Depending on the environment, these tiny particles can remain suspended in the air for several hours. M. tuberculosis is transmitted through the air, not by surface contact. Infection occurs when a person inhales droplet nuclei containing M. tuberculosis, and the droplet nuclei traverse the mouth or nasal passages, upper respiratory tract, and bronchi to reach the alveoli of the lungs. Persons with extrapulmonary TB disease may have concurrent unsuspected pulmonary or laryngeal TB disease. Except for laryngeal TB disease, extrapulmonary TB disease is rarely infectious; however, transmission from extrapulmonary sites has been reported to occur during aerosol-producing procedures such as autopsies and tissue irrigation. The characteristics of a patient with TB disease that are associated with infectiousness include, but are not limited to, those listed in Table 7.1.

 

MMWR Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005

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Persons with extrapulmonary TB disease usually are not infectious unless they have concomitant pulmonary disease, nonpulmonary disease located in the oral cavity or the larynx, or extrapulmonary disease that includes an open abscess or lesion in which the concentration of organisms is high, especially if drainage from the abscess or lesion is extensive, or if aerosolization of drainage fluid is performed (69,72,77,83,301). Persons with TB pleural effusions might also have concurrent unsuspected pulmonary or laryngeal TB disease. These patients should be considered infectious until pulmonary TB disease is excluded. Patients with suspected TB pleural effusions or extrapulmonary TB disease should be considered pulmonary TB suspects until concomitant pulmonary disease is excluded (302).