Extrapulmonary tuberculosis, part 1: Pleural and lymph node disease
نویسندگان
چکیده
Pleural tuberculosis and lymph node involvement are the most common extrapulmonary manifestations of tuberculosis. Most patients with pleural involvement complain of pleuritic chest pain, nonproductive cough, and dyspnea. The pleural effusion is usually unilateral and small to moderate in size. The diagnosis depends on the demonstration of acid-fast bacilli in pleural fluid or biopsy specimens, or the presence of caseous granulomas in the pleura. The gold standard for the diagnosis of lymph node tuberculosis is the identification of mycobacteria in smears on fine-needle aspiration cytopathology, histopathology, or mycobacterial culture. On ultrasonography and CT, the lymph nodes show enlargement with hypoechoic/hypodense areas that demonstrate central necrosis and peripheral rim enhancement or calcification. Treatment involves the combination of 4 antituberculosis drugs for 2 months, followed by 2-drug therapy for 4 months. (J Respir Dis. 2005;26(8):326-332) In the past decade, there has been a significant increase in the prevalence of tuberculosis and its extrapulmonary manifestations worldwide.1 Factors that have contributed to this include the rising number of immunosuppressed persons, the development of drugresistant strains of Mycobacterium tuberculosis, aging-population demographics, and an increase in the number of health care workers who are exposed to tuberculosis.2 The incidence of extrapulmonary manifestations is approximately 50% in patients who have both AIDS and tuberculosis, compared with 10% to 15% in HIV-negative patients with tuberculosis.3 Tuberculosis that involves the lymph nodes, bone (excluding the spine), peripheral joints, or skin is classified as a less severe form of disease. The severe forms include meningitis, abdominal involvement, miliary tuberculosis, pericarditis, bilateral or extensive pleural effusion, spinal involvement, and genitourinary involvement. In some patients, it can be difficult to make the diagnosis of extrapulmonary tuberculosis. Although imaging studiesor a positive tuberculin skin test may support the diagnosis, negative results do not exclude extrapulmonary tuberculosis.4 However, recognition of the common and uncommon radiologic findings can be helpful. In a series of articles, we will focus on the more common forms of extrapulmonary tuberculosis. In this article, we will review the presentation and diagnosis of pleural and lymph node (peripheral and mediastinal) involvement. In coming issues of The Journal of Respiratory Diseases, we will discuss CNS, abdominal, and skeletal manifestations of tuberculosis.PLEURAL TUBERCULOSIS Lymph node involvement and pleural tuberculosis are the 2 most common extrapulmonary manifestations of tuberculosis. Most cases are caused by M tuberculosis; a fewcases caused by other mycobacteria, including Mycobacterium bovis, have been reported.5 Tuberculous pleural effusion is usually seen in children and young adults. It characteristically occurs 3 to 7 months after initial infection with M tuberculosis. An upward shift in the age spectrum and a more frequent association with reactivation disease have been reported in many series in the past decade.6,7 Underlying pulmonary parenchymal disease is also being documented, thereby confounding the classification of pleural disease as extrapulmonary tuberculosis. In general, patients who have tuberculous pleural effusion are younger than patients who have parenchymal tuberculosis.8Pathogenesis Neutrophils appear to play a key role in the initiation of inflammatory reactions in tuberculous effusion. In addition, pleural mesothelial cells produce a neutrophil chemotactic cytokine, interleukin (IL)-8, and a mononuclear cell chemotactic cytokine, monocyte chemotactic peptide-1 (MCP-1). MCP-1 is produced by inflammatory macrophages and endothelial cells. This cytokine may be at least partly responsible forthe recruitment of macrophages.
منابع مشابه
[Extrapulmonary tuberculosis].
Although the respiratory tract is the major site for tuberculous lesions, all organs can be affected. The authors review the clinical files of 25 patients admitted to our Department with lung and/or pleural tuberculous disease, confirmed by bacteriology or histopathology, who simultaneously suffered from tuberculosis in other organs. We included 20 men and 5 women, aged from 10 to 74 years (mea...
متن کاملA systematic review of commercial serological antibody detection tests for the diagnosis of extrapulmonary tuberculosis.
Conventional diagnostic tests for tuberculosis have several limitations and are often unhelpful in establishing the diagnosis of extrapulmonary tuberculosis. Although commercial serological antibody based tests are available, their usefulness in the diagnosis of extrapulmonary tuberculosis is unknown. A systematic review was conducted to assess the accuracy of commercial serological antibody de...
متن کاملIsolated axillary lymph node tuberculosis in ultrasonography. A case report
We present a rare case of isolated axillary lymph node tuberculosis. A 66-year-old patient was admitted in order to perform the diagnostics of a painless tumor of the left armpit. Blood biochemistry tests and chest X-ray did not show any abnormalities. In the ultrasound examination a solid structure of the dimensions of 1.8×1 cm of irregular outline with adjacent hypoechogenic lymph nodes was v...
متن کاملVarious manifestations of extrapulmonary tuberculosis and its relationship with HIV-AIDS
Tuberculosis is known from ancient times. Recently HIV and Tuberculosis emerged as an important treatable co-epidemic especially in developing countries. Extra-Pulmonary Tubercular involvement is one of the important manifestations of Tuberculosis especially in HIV co-infected patients. But the extrapulmonary manifestations vary between patients of Tuberculosis with HIV and without HIV co infec...
متن کاملExtrapulmonary tuberculosis in Poland in the years
Introduction: The incidence of tuberculosis in Poland decreased from 128.5 in 100 000 in 1970 to 19.1 in 100 000 in 2010. In many countries, but not in Poland, according to the improvement of the epidemiological situation of tuberculosis (TB), the proportion of the extrapulmonary form of this disease is increasing. The aim of this study was to describe changes in extrapulmonary TB epidemiology ...
متن کامل