Pulmonary Tuberculosis Disseminating and Presenting as Bilateral Hydronephrosis and Renal Abscess: a Potential Threat in the Era of Multi-Drug Resistant Tuberculosis MDR-TB

Mycobacterium tuberculosis, the causative agent of tuberculosis was discovered by Robert Koch in 1882. It has been observed that 30% of the world population harbours Mycobacterium tuberculosis. Spread of Human immunodeficiency virus (HIV) infection, malignancies, globalization and malnutrition are some of the major contributing factors for increase in the global burden of tuberculosis (pulmonary and extra-pulmonary TB). Dissemination/spread of tubercle bacilli from the lungs to other organs of the body either through blood or lymphatic circulation results in extra-pulmonary tuberculosis. Immunodeficiency, either due to HIV infection or malignancies, malnutrition and inadequate treatment for pulmonary TB may be considered as some of the predisposing factors for disseminated/miliary TB. It has also been noted that most cases of extra-pulmonary TB are diagnosed accidentally and after a long period of time (months to years) since recovering from pulmonary TB. In the era of Multi-drug resistant tuberculosis (MDR-TB), extremely drug resistant tuberculosis (XDR-TB) and increase in the incidences of disseminated/extra-pulmonary tuberculosis poses a challenge to the medical personnel. Among the extra-pulmonary cases of tuberculosis genitourinary tuberculosis (GUTB) appears to be most frequent as evidenced by the available