Extrapulmonary Tuberculosis And Diagnosis

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Extrapulmonary Tuberculosis And Diagnosis

        Harvested pathological products are: sputum, pleural fluid, urine, CSF, bone marrow aspirates, ascites fluid, lymph fragments.

  • spontaneous sputum is harvested after a preliminary washing of the mouth with saline, or by suctioning secretions from the bronchial tree;
  • pleural fluid is taken only by the doctor by pleural puncture;
  • urine is collected in case of suspicion of renal tuberculosis in the morning, the first urination after a rigorous external toilet. Because the elimination of bacilli is intermittent, it is recommended to repeat the harvesting within a few days.
  • harvesting by CSF puncture is made in diagnosis purposes in meningitis tuberculous;
  • the aspiration of bone marrow , biopsy and curettage fragments of bone lesions are considered when establishing the diagnosis of bone tuberculosis;
  • ascites fluid, fragments of peritoneum, mesenteric lymph nodes are harvested by surgery, in case of peritoneal, intestinal or abdominal tuberculosis

       The tuberculosis diagnosis consists either directly in smear examination, Ziehl-Neelsen stained either directly from the product as such or after mixing and prior to its merger with NaOH. Bacilli appear in the form of thin rods, they are curved and red. They are rarely isolated. Bacilli can be viewed by UV light microscopic examination, using staining technique with a mixture of cold-rhodamine auramine. Bacilli will appear on the black fluorescent preparation.

       Isolation. Seeding pathological product on solid culture media (Lowenstein-Jensen), after prior decontamination (treatment with NaOH to destroy associated flora) allows identification of biochemical tests, and determine sensitivity to tuberculostatics germs. Mycobacterial multiplication in vitro is slow therefore emergence of colonies on culture medium occurs after a minimum incubation time of 14 days (maximum 4 weeks).

Extrapulmonary tuberculosis pictures

Extrapulmonary tuberculosis pictures Extrapulmonary tuberculosis pictures Extrapulmonary tuberculosis pictures

       Identification of colonies of Mycobacterium tuberculosis is based on cultural characteristics and enzymatic tests (catalase test, niacin test , peroxidase test, test to tuberculostatics).

       New methods for rapid tuberculosis diagnosis

  • PCR detects DNA of M.tuberculosis in CSF;
  • amplification of ribosomal RNA;
  • ELISA detects specific antigens in CSF;
  • tuberculostearic and mycolic acid detection.

Extrapulmonary tuberculosis

       Extrapulmonary tuberculosis can be:

  • renal tuberculosis;
  • peritonitis tuberculosis;
  • pericarditis tuberculosis;
  • lymph node TB;
  • bone and joint tuberculosis;
  • gastrointestinal tuberculosis;
  • liver TB;
  • TB meningitis

       Extrapulmonary tuberculosis has become chronic and presents several complications for the patient. Some illnesses such as meningitis and peritonitis may be dangerous for the patient life from the beggining. It requires diagnosis and urgent treatment. In the past, node, tonsillar, bone and gut tuberculosis was caused by consumption of unpasteurized milk, infected by a virus similar to Koch bacillus. Today, however, by milk pasteurization, this risk has decreased considerably.

       Extrapulmonary tuberculosis affects people with weak immune system, diabetes, HIV, or malnourished people, very young children or elderly, those undergoing prolonged treatment with chemotherapy or cortisone. Among the most common forms of extrapulmonary tuberculosis are node tuberculosis, osteo-articular, renal and skin tuberculosis. Meningitis may accompany pulmonary tuberculosis or be an independent disease. Commonly it occurs in children between one and five years and affects the elderly people too.

        It is manifested by fever, headache, nausea, dizziness, subsequent neurological symptoms and coma. Tuberculous meningitis may be confused with meningitis caused by other microbes and is diagnosed by isolation of Koch bacillus in the cerebrospinal fluid. Node tuberculosis involves in particular, the nodes in the neck, which increase in volume, become slightly painful and untreated in time, can cause skin ulcers and fistulas. Injuries caused by node chronic tuberculosis require surgery and leave scarring.