Tb Or Not Tb: Unusual Presentation Of Disease

Introduction

According to Texas Health and Human Services, recently in Harris County there has been double the amount of cases of tuberculosis (TB) than the national average. Due to it’s increasing incidence it is important to be aware of the usual symptoms of TB such as chronic coughing, as well as more unusual symptoms that present in Extra Pulmonary TB (EPTB). The following review discusses rare presentations of TB and methods of diagnosis.

Review of Literature

Research by (Yusof et al., 2016) found the following:

This case report shares 3 cases of uncommon presentations of Tuberculosis and discussed how they were diagnosed and treated.

Histopathalogical examination found positive acid fast bacilli in their smear samples. The first case is of a 13 year old boy who presented with painful swelling in the right side of his neck fever, weight loss, and loss of appetite but not the usual presentations of chronic cough, night sweat, or any known TB contact. The second case is of a 65 year old male who presented with the usual coughing, dysphagia, odynophagia, and hoarseness but a negative initial TB test.

The third case was of a 65 year old that presented with redness and pain over the left pre-auricular area. All of these cases show that usual symptoms of TB may not be present and further tests of all these symptoms was necessary to diagnose TB.

Research by (Lee, 2015) found the following:

This article discusses how extra pulmonary tuberculosis (EPTB) is diagnosed and treated. TB can be diagnosed definitely by culturing the mycobacterium tuberculosis from a patient sample which can be time consuming and challenging to get an appropriate sample.

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A tissue biopsy can yield more positive results than a fluid aspiration sample and samples must be fresh. Body fluid examinations, nucleic acid amplification tests, and immunological tests are also ways of diagnosing TB.

Research by (Sharma et al., 2017) found the following:

This systematic review uses research to summarize guidelines to diagnose and treat extra pulmonary tuberculosis. The authors state that diagnosis can be difficult and that most research is focused on pulmonary TB. A study in India showed that 2.1 million cases of TB in India, 336,000 cases were EPTB in 2013. Forms of EPTB that is examined in this review include lymph node TB, TB meningitis, TB pericarditis, and abdominal TB. Each of these have different methods of diagnosis that would be best. For example, Xpert MTB/ RIF (nucleic acid amplification test) along with the conventional smear microscopy should be used to diagnose lymph node TB but for pleural TB Xpert MTP/ RIF would not be used.

Conclusion

In conclusion, these articles all state that EPTB is prevalent, though much less common than pulmonary tuberculosis. In the first 3 cases presented in the first case review, these examples show that it may be difficult to diagnose TB from symptoms such as swelling and pain. If patients presents with these symptoms but have not injured themselves, tests for TB should be done even though the patient does not recall coming in contact with TB or has travelled out of the country themselves. The second two article reviews summarize methods of diagnosis for extra pulmonary TB since different methods are used compared to pulmonary TB.