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It is crucial to make an effort for microbiological confirmation in presumptive Extrapulmonary Tuberculosis (EPTB) cases. Appropriate specimens from the Extrapulmonary (EP) site are collected and, depending on the specimen type and availability of facilities, the specimens are sent for:

  • Cartridge-based Nucleic Acid Amplification Testing (CBNAAT)
  • Culture and Drug Susceptibility Testing (C&DST) for M. tuberculosis 
  • Histopathological examination

 

The diagnostic algorithm (see the figure below) to be followed for EPTB cases depends on 2 main factors:

  1. Availability of appropriate specimens from the EP site
  2. Availability of CBNAAT (preferred test)

Figure: Diagnostic Algorithm of EPTB

 

  • If an appropriate specimen from the EP site is available, specimens from the presumed sites of involvement must be tested with CBNAAT.
  • CBNAAT detects MTB and RIF status and helps to identify microbiologically confirmed EPTB cases.
  • If CBNAAT is not available, the specimen is sent for Liquid Culture (LC) at the C&DST lab. If the LC is positive, it is identified as a microbiologically confirmed EPTB case.
  • If there is high clinical suspicion of TB even after a negative culture result, other diagnostic tools are used to clinically diagnose EPTB (usually with a specialist). If these tests indicate TB, they may be treated as clinically diagnosed EPTB or else arrive at an alternate diagnosis.

 

Clinical Diagnosis of EP-TB

If an appropriate specimen from the EP site is not available, in the presence of high clinical suspicion of TB, other modalities of diagnosis are used in consultation with a specialist. If with other diagnostic modalities, TB diagnosis still cannot be established, the specialist may explore an alternate diagnosis. 

A clinical diagnosis of EPTB is made if a consultative decision is made to treat with a full course of anti-TB drugs in spite of the situations listed above. Chest X-ray (CXR), ultrasonography, Computerised Tomography (CT) scan, Magnetic Resonance Imaging (MRI) and biochemical examinations are supporting tests that can be used to help arrive at a diagnosis.

 

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Assessment

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Question​ Answer 1​ Answer 2​ Answer 3​ Answer 4​ Correct answer​ Correct explanation​ Page id​ Part of Pre-test​ Part of Post-test​
Which of the following statements are correct? We must try our utmost best to get a microbiological confirmation in presumptive extrapulmonary tuberculosis cases. If the extrapulmonary specimen is not available, then consult with a clinician if there is a high suspicion of TB to diagnose the case. Wherever possible, all extrapulmonary specimens must be subjected to CBNAAT. All of the above 4 Microbiological confirmation is crucial for EPTB cases, and CBNAAT is the preferred test. If specimens are not available, but TB is highly suspected, then a clinical diagnosis can be sought in consultation with a specialist.   Yes Yes

 

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