Tuberculosis extrapulmonary

Mycobacterium tuberculosis var. hominis is the primary cause of tuberculous meningitis. Tuberculous meningitis may exist in the absence of disease in the lung or extrapulmonary sites. Upon initial examination, CSF usually contains 100 to 1,000 WBC/mm3, which may be 75% to 80% polymorphonuclear cells. Over time, the pattern of WBCs in the CSF will shift to lymphocytes and monocytes. 

Lymphoma, Burkitt s Lymphoma, immunoblastic Lymphoma, primary, or brain Mycobacterium avium complex or M. kamasii, disseminated or extrapulmonary M. tuberculosis, any site (pulmonary or extrapulmonary) Mycobacterium, other species or unidentified species, disseminated or extrapulmonary Pneumocystis carinii pneumonia Pneumonia, recurrent... 

Treatment of active pulmonary and extrapulmonary tuberculosis (including renal disease) when organisms are susceptible, after failure of adeguate treatment with the primary medications. Use in conjunction with other effective chemotherapy. P.1017... 

Tuberculosis (frequently disseminated or extrapulmonary at clinical presentation), invasive fungal infections, and other opportunistic infections have been observed in patients receiving infliximab. Some of these infections have been fatal (see Warnings). 

Risk of Infection Cases of tuberculosis (frequently disseminated or extrapulmonary) have been reported during therapy... 

Reactivation of latent tuberculosis is a major concern with infliximab (SEDA-26, 402), and accounts for about one-third of infections in these patients. According to data from the manufacturers, 130 cases of active tuberculosis were notified up to October 2001. Many of the cases were disseminated or extrapulmonary tuberculosis, and several patients died. Several case reports have provided detailed information in at least seven other patients, including three who developed miliary tuberculosis and one who developed Mycobacterium tuberculosis enteritis (44-48). A detailed analysis of 70 cases of tuberculosis reported to the FDA has been published (49). Two-thirds of the cases were noted after three or fewer infusions and 57% of the patients had extrapulmonary disease. There were 64 cases from countries with a low incidence of tuberculosis. From these reports and the number of patients treated with infliximab, the estimated rate of tuberculosis in patients with rheumatoid arthritis treated with infliximab was four times higher than the background rate. Patients with evidence of active infection should not receive infliximab until the infection is under control all should be screened for tuberculosis before starting infliximab (50). From these and other data it has been estimated that the risk of tuberculosis in the first year of infliximab treatment is 0.035 in US citizens and 0.2% in non-US citizens. Further investigations, such as a chest X-ray and a Mantoux test, and prophylactic treatment with isoniazid, will show whether the incidence can be reduced in patients taking anti-TNF treatment (51). 

Iseman MD. Extrapulmonary Tuberculosis in Adults A Clinician s Guide to Tuberculosis. Philadelphia, Lippincott Williams Wilkins, 2000 145-197. 

TABLE 110—4- Evidence-Based Guidelines for the Treatment of Extrapulmonary Tuberculosis and Adjunctive Use of Corticosteriods ... 

Duration of therapy for extrapulmonary tuberculosis caused by drug-resistant organisms is not known. Corticosteroid preparations vary among studies. 

Patients with CNS tuberculosis usually are treated for longer periods (9 to 12 months instead of 6 months) (Table 110-4). In general, isoniazid, pyrazinamide, ethionamide, and cycloserine penetrate the cerebrospinal fluid (CSF) readily, but rifampin, ethambutol, and streptomycin have variable CNS penetration." Of the quinolones, levofloxacin may be preferred based on current data. Extrapulmonary TB of the soft tissues can be treated with conventional regimens. 

Mycobacterium tuberculosis, any site (pulmonary or extrapulmonary) Mycobacterium, other species or unidentified species, disseminated or extrapulmonary... 

Tuberculosis. Korn et al. (K30) reported serum alkaline phosphatase elevation in 41% of a group of patients with extrapulmonary tuberculosis and claimed that elevated values tended to be associated with granulomatous infiltration of the liver. Munt (M40) found hyperphosphatasemia in 34% of patients with miliary tuberculosis, but could demonstrate no correlation between serum alkaline phosphatase and liver histology. Many of the patients studied by Korn et al. (K30) had fatty... 

Being a hydrazid derivative it is the main stay of primary treatment of pulmonary and extrapulmonary tuberculosis. 

VoUc, R. Rubrophen in the treatment of extrapulmonary tuberculosis. Wiener Medizinische Wochenschrift 1938, 88,173-176 Chem. Abstr. 1939,33, 14763. 

In a retrospective study in Brazil in 319 patients who underwent liver transplant and survived more than 1 month tuberculosis was identified in five women, mean age 40 years [ST f. None received chemoprophylaxis before or after liver transplant. Two had disseminated tuberculosis, two had pulmonary disease, and one had extrapulmonary disease. Cultures were positive in four. Four patients received isoniazid, rifampicin, and... 

Infection risk There have been reports of tuberculosis in patients receiving adalimumab, in most cases extrapulmonary [105 ]. The risk of tuberculosis was higher in patients receiving anti-TNF monoclonal antibodies than those who were receiving soluble TNF receptors. Some patients who have previously received treatment for latent or active tuberculosis have developed active tuberculosis while being treated with adalimumab. 

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