Extrapulmonary TB: New Diagnostics and New Policies

Authors: Ruvandhi Nathavitharana, MD, MPH—Author; Madhukar Pai, MD, PhD—co-author and Series Editor
Number of pages: 6
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Overview: Clinical presentations of extrapulmonary TB (EPTB) is diverse, leading to missed cases and delayed diagnoses. Since the diagnosis of EPTB is often compromised by the paucibacillary nature of the disease, new diagnostic tools and policies have been eagerly awaited. At long last, new tools, and new policies are here. The International Standards for TB Care (ISTC) recommends that all patients, including children, who are suspected of having EPTB, should have appropriate specimens obtained from the suspected sites of involvement for microbiological and histological exam. The World Health Organization (WHO) has endorsed the use of Xpert MTB/RIF assay (Cepheid Inc., Sunnyvale, California), a cartridge based nucleic acid amplification test (NAAT), for EPTB. Xpert MTB/RIF is now considered a central test in the work-up of EPTB, and should be used along with existing tools such as microscopy, liquid cultures (which are the most sensitive technologies for MTB detection), and histopathology (biopsy) to arrive at the final diagnosis. Xpert is particularly useful in cerebrospinal fluid samples and in lymph node and other tissues. Once diagnosed, EPTB must be treated with standardized treatment regimens, as recommended by ISTC.

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Extrapulmonary Tuberculosis: New Diagnostics and New Policies

5 thoughts on “Extrapulmonary TB: New Diagnostics and New Policies

  1. Sir, for tubercular lymphadenitis, would FNAC coupled with Mantoux or IGRA be a reasonable option in a resource limited setting to confirm a diagnosis?

    1. For suspected TB lymphadenitis, biopsy or FNAC is necessary. The tissue should be sent for histopathology and Xpert MTB/RIF (GeneXpert) testing (liquid cultures can also be done). Mantoux or IGRA are not indicated, since many Indians are latently infected, and these tests cannot separate latency from active TB. Xpert MTB/RIF has high accuracy on lymph node tissues and are recommended by WHO.

  2. What should be the method for proper diagnosis of spinal TB?
    Biopsy is already done but not conclusive.
    Slides that were used for evaluation are available, if further verification is required to be done.

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