Focus on Extra-Pulmonary (Non-Pulmonary / Non Lungs) TB
Q1: Is TB always a lung disease?
No. TB is broadly of two main types:
Pulmonary TB – affecting the lungs
Extra-Pulmonary TB (EPTB) – affecting organs outside the lungs, such as lymph nodes, pleura, abdomen, bones, spine, brain, urinary tract, or reproductive organs.
Q2: What is Extra-Pulmonary TB?
Extra-Pulmonary TB means TB involving any part of the body other than the lungs. Common forms include:
Lymph node TB (neck swelling)
Pleural TB (fluid around lungs)
Abdominal TB
Spine/Bone TB
Brain TB / TB meningitis
Genitourinary TB
Female genital TB causing infertility
Approx. 40 – 45 % TB is Nonpulmunary TB
But it doesn’t spread from one person to another
Q3: What are the common symptoms of Extra-Pulmonary TB?
Symptoms depend on the organ involved, so they are often non-specific:
Persistent neck swelling / lymph node enlargement
Unexplained fever
Weight loss
Loss of appetite
Back pain (spinal TB)
Abdominal pain, ascites, altered bowel habits
Headache, vomiting, fits (brain TB)
Infertility or menstrual irregularity in women
Pleural effusion causing chest pain and breathlessness.
Q4: Why is diagnosis often delayed in EPTB?
Because unlike pulmonary TB, cough may be absent. Symptoms mimic many other diseases such as cancer, chronic infections, arthritis, or abdominal disorders like Acidity, leading to delay in suspicion and diagnosis.
Q5: How is Extra-Pulmonary TB diagnosed?
Diagnosis usually requires a combination of:
Ultrasound / CT / MRI
X-ray
FNAC or biopsy
Fluid analysis (pleural, ascitic, CSF)
CBNAAT / Truenat / molecular tests
Histopathology when needed.
Q6: Is the treatment different from lung TB?
Most forms of EPTB are treated under the National TB Elimination Programme with free anti-TB medicines, usually similar to pulmonary TB regimens. However, brain TB, spine TB, and some severe abdominal forms may require longer duration or specialist follow-up.
Q7: Can Extra-Pulmonary TB be completely cured?
Yes. With timely diagnosis and full adherence to treatment, most EPTB cases are completely curable.
Q8: What should the public remember?
Any persistent unexplained swelling, fever, back pain, abdominal fluid, or weight loss should not be ignored, especially in high-risk groups such as diabetes, HIV, malnutrition, and close contacts of TB patients
.
Conclusion:
TB is not only a disease of the lungs. Extra-Pulmonary TB can affect almost any organ and often gets missed because symptoms are silent or misleading. Early suspicion, correct diagnosis, and complete treatment are essential to achieve a TB-free India.
Dr. S.K. Arora
Senior Chest Specialist, Consultant,
Ex-Delhi State TB Head, Delhi Government
(Recipient of WHO Award )
