Specific considerations in extrapulmonary tuberculosis

Extrapulmonary tuberculosis (TB) is not an infection risk in the absence of lung disease.

Many forms of extrapulmonary TB (eg lymph node, pleural, genitourinary, musculoskeletal) can be treated with standard short-course therapy, but expert advice is required.

Clinical trials to evaluate duration of therapy in extrapulmonary TB are lacking. Current guidelines suggest the standard duration of short-course therapy (ie 6 months) is sufficient for most forms of extrapulmonary TB including miliary TB, and in those with HIV co-infection. An exception is TB meningitis, when treatment is extended to 12 months. Courses longer than 6 months may also be required in complicated musculoskeletal disease (eg Pott’s disease). Consider extending the duration of treatment in patients with TB that is slow to respond, regardless of the site of infection.

Adjunctive surgical management (eg for relief of ureteric obstruction or spinal cord compression) is sometimes required.

Lymph nodes infected with TB (tuberculosis lymphadenitis) can increase in size or form sinuses during and after treatment—this response is an immunological reaction to dead bacilli and does not indicate treatment failure.