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Extrapulmonary tuberculosis
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DOI：10.1007/s10405-025-00657-1.png)
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Abstract
En 中文
Background: Germany is a low-incidence country for tuberculosis (TB). Around 25% of TB patients only show an extrapulmonary tuberculosis (EPTB). Due to its rarity, its clinically heterogeneous presentation and specific diagnostic and therapeutic aspects, EPTB poses a challenge for physicians of various specialist disciplines in Germany. Objective: The epidemiology, pathophysiology and risk factors for the development of EPTB as well as possible clinical, diagnostic and therapeutic aspects are presented. Material and methods: This review article is based on current national and international data and recommendations for the diagnostics and treatment of EPTB. Results: In Germany EPTB most commonly affects the lymph nodes, followed by the pleura, the skeletal system, the gastrointestinal tract, the urogenital tract and the central nervous system (CNS). When invasive diagnostic samples are taken, patients with appropriate but often unspecific symptoms and risk factors for EPTB, e.g., human immunodeficiency virus (HIV), immunosuppression, origin from a TB endemic area, should always be tested for TB and it should be assured that the necessary preanalytical steps are carried out correctly. Microbiological findings should be interpreted in the clinical context, taking the sometimes limited sensitivity of diagnostic assays (paucibacillary samples) into account. Therapeutic features of EPTB include prolonged treatment duration for bone, CNS and disseminated TB as well as mandatory glucocorticoid treatment for TB of the CNS. The treatment response is evaluated using a combination of clinical findings and imaging techniques. Conclusion: The EPTB is an important differential diagnosis in patients with relevant risk factors for TB and unspecific symptoms. A comprehensive evaluation and interdisciplinary interpretation of the clinical, microbiological and pathological findings is often necessary to make a diagnosis.
Keywords:
Disseminated tuberculosis
Tuberculous lymphadenitis
Paradoxical reaction
Microbiological findings
Risk facrors
Disseminated tuberculosis
Tuberculous lymphadenitis
Paradoxical reaction
Microbiological findings
Risk facrors