Concerns Associated with Extra-pulmonary Tuberculosis

Source-This post on Concerns associated with Extra-pulmonary tuberculosis has been created based on the article “The challenge of extra-pulmonary TB” published in “The Hindu” on 14 May 2024.

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Context– Almost one out of every five TB patients have EPTB. Many of them aren’t diagnosed, and even those who are diagnosed can’t get proper care unless they go to specific specialist hospitals. Thus, the article highlights the need for proper diagnosis and treatment of Extra-Pulmonary Tuberculosis (EPTB). Concerns Associated with Extra-pulmonary Tuberculosis

What is Extra-Pulmonary Tuberculosis (EPTB)?

EPTB refers to tuberculosis infections that occur outside the lungs, affecting organs such as lymph nodes, brain, gut, eyes, and others.

A troubling aspect of EPTB infection is the prolonged presence of disease markers even after the infection is resolved with treatment.

It can affect various organs, leading to irreparable damage if left untreated. For ex- EPTB in the eyes can result in vision loss or blindness.

What are the challenges in estimating the burden of EPTB?

1) Detecting Extra-Pulmonary Tuberculosis– It is difficult to detect through regular TB stain tests as it may not present with corresponding lung infections. This stain-negative nature and the ability of EPTB to imitate other non-TB conditions make its prevalence difficult to detect.

2) Awareness– Lack of awareness among physicians and the absence of accurate diagnostic and treatment criteria contribute to the challenge.

3) Expert working in silos-Because TB can affect different organs, the absence of proper protocols for doctors from various fields to share information creates separate areas of expertise. This makes it difficult to collaborate effectively.

4) Implementing EPTB Guidelines– Experts from various health institutions, the WHO, and the Cochrane Infectious Disease Group made guidelines called INDEX-TB for managing EPTB in India.
Unfortunately, this effort hasn’t moved forward, and there are still no diagnosis and treatment plans for all affected organs.

5) Data Collection standards-The specialized departments in large public hospitals have different ways of collecting data, and their information isn’t shared with the National TB Control Program. Therefore, it is not known how common EPTB is.
For ex- Ni-kshay- the national patient management portal for TB control, do not have adequate data on EPTB patients.

6) Underexplored Aspects of EPTB Infection-Important aspects of EPTB, such as how the infection spreads and how the TB bacterium interacts with organs, are under-explored.

Read more- Tuberculosis- Role of private sector in Elimination

What should be the way forward?

1) It is essential to develop diagnosis and treatment protocols for all organs affected by EPTB based on high-quality data from clinical trials.

2) Advanced tools like single-cell RNA sequencing could aid in uncovering more effective treatment approaches.

3) The INDEX-TB guidelines were created more than ten years ago and should be updated with new information and knowledge. They should also involve experts from different healthcare fields to be more comprehensive.

Question for practice

What is extra-pulmonary tuberculosis (EPTB)? What are the challenges in estimating the burden of EPTB?