Home   »   Science and Technology UPSC Notes   »   Extra Pulmonary TB

What is Extra Pulmonary Tuberculosis?


  • Extrapulmonary tuberculosis (EPTB) affects organs other than the lungs, such as lymph nodes, brain, gut, and eyes, accounting for about 20% of TB infections.
  • Unlike pulmonary TB, EPTB often doesn’t show up in standard TB stain tests and may not involve a corresponding lung infection, making it difficult to diagnose.
  • The World Health Organization (WHO) reports over 10 million new TB cases annually, with India accounting for 27% of the global TB burden.
  • The burden of EPTB is high, ranging from 15– 20% of all TB cases in HIV-negative patients, while in HIV-positive people it accounts for 40–50% of new TB cases.
    • However, the true prevalence of EPTB is likely underestimated due to diagnostic challenges.

Extrapulmonary Tuberculosis (EPTB)

What is Extra Pulmonary Tuberculosis?_4.1

Extra Pulmonary TB Challenges

Public Health Challenges

  • Underdiagnosis: EPTB is often not detected by regular TB tests and its symptoms can mimic those of non-TB conditions. This leads to a significant number of undiagnosed or misdiagnosed cases.
  • Damage and Complications: The underdiagnosis of EPTB can result in irreversible damage to affected organs, including vision loss or blindness in cases where the infection is in the eye.

Knowledge and Treatment Gaps

  • Lack of Awareness and Expertise: There is a significant knowledge gap among healthcare providers regarding EPTB, particularly about its occurrence in organs that have immune privileges. This complicates the diagnosis and treatment efforts.
  • Diagnosis and Treatment: Accurately diagnosing and effectively treating EPTB is challenging due to the lack of awareness and the absence of specific diagnostic and treatment protocols for different organs.

Collaborative Efforts and Guidelines

  • INDEX-TB Guidelines: In 2014, a consortium of health experts from various institutions, the WHO, and the Cochrane Infectious Disease Group developed INDEX-TB, a set of guidelines for managing EPTB in India.
    • However, these guidelines are based on good-quality evidence for only five organs and need updating.
  • Need for Better Data Collection: Effective EPTB management is hindered by diverse data practices across specialist departments.
    • There is a call for these departments to standardise data collection and share it with the National TB Control Programme to enhance the Ni-kshay portal, which currently lacks comprehensive EPTB patient data.

Research Priorities

  • Understanding EPTB Mechanisms: Research is needed to explore how the TB bacterium interacts with different organs and the prolonged immunological responses even after the infection has been treated.
    • This includes studying phenomena like persistent intraocular inflammation in the eye.
  • Advanced Tools: Utilising advanced immunological tools like single-cell RNA sequencing could help reveal the immune mechanisms involved in EPTB, potentially leading to more effective treatments.
  • Long-Term Treatment Challenges: Current treatments often involve prolonged anti-TB therapy, which may not always be effective and can expose patients to significant side effects.

Future Directions

  • Updating INDEX-TB Guidelines: There is a crucial need to update the INDEX-TB guidelines with the latest data and multidisciplinary inputs to reflect the complex nature of EPTB.
  • Clinical Trials for High-Quality Data: Conducting clinical trials is essential to develop and refine diagnosis and treatment protocols for all organs affected by EPTB.

Sharing is caring!

About the Author

I, Sakshi Gupta, am a content writer to empower students aiming for UPSC, PSC, and other competitive exams. My objective is to provide clear, concise, and informative content that caters to your exam preparation needs. I strive to make my content not only informative but also engaging, keeping you motivated throughout your journey!

Leave a comment

Your email address will not be published. Required fields are marked *