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Tuberculous Pleural Effusion
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Tuberculous Pleural Effusion
A 74-year-old man complained of abnormal fatigue, night sweats, and unintended weight loss of 4 kg over the past month. A thoracentesis of his extensive right-sided pleural effusion showed an exudate with a leukocyte count of 2400/µL, 96% of which were mononuclear cells. No pathogen was detected under the microscope or in culture, and examination of the exudate by polymerase chain reaction for Mycobacterium tuberculosis was negative. F-18-FDG PET computed tomography was performed to rule out malignancy. Computed tomography-guided pleural biopsy demonstrated epithelioid cell granulomas with caseation. Tuberculous pleurisy was diagnosed and quadruple therapy for tuberculosis was initiated (isoniazid, rifampicin, pyrazinamide, ethambutol). Shortly after commencement of this treatment, the night sweats and lassitude remitted and the patient gained weight; he felt much better. A 6-month course of treatment was accomplished (2 months of quadruple therapy, then 4 months of isoniazid and rifampicin). The patient recalled having been in contact with tuberculosis patients in his childhood.
Dr. Med. Hilte Friederike Geerdes-Fenge, Prof. Dr. Med. Emil Christian Reisinger, Zentrum für Innere Medizin, Abteilung für Tropenmedizin und Infektionskrankheiten, Universitätsmedizin Rostock, hilte.Geerdes-fenge@uni-rostock.De
Dr. Med. Juliane Becker, Zentrum für Radiologie, Klinik und Poliklinik für Nuklearmedizin, Universitätsmedizin Rostock
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare
Cite this as: Geerdes-Fenge HF, Becker J, Reisinger EC: Tuberculous pleural effusion. Dtsch Arztebl Int 2018; 115: 839. DOI: 10.3238/arztebl.2018.0839
What Is Tuberculous Spondylitis?
Tuberculous spondylitis is a TB infection that affects the spine. It may cause back pain and, in severe cases, deformity or neurological issues.
Tuberculous spondylitis is a tuberculosis (TB) infection of the spine. Other terms for tuberculous spondylitis include spinal TB or Pott disease.
Tuberculous spondylitis may cause back pain and other symptoms of TB. Treatments may include medications to destroy TB bacteria and surgery to correct spinal issues.
This article examines the symptoms, causes, diagnosis, treatment, and outlook for tuberculous spondylitis.
Tuberculosis spondylitis is a type of TB that affects the spine. It is a type of extrapulmonary TB, which occurs if a TB infection spreads outside of the lungs to other areas of the body.
TB mainly affects the lungs, which doctors refer to as pulmonary TB. Extrapulmonary TB accounts for around 15–20% of all instances of TB.
Tuberculous spondylitis is the most common type of TB affecting the musculoskeletal system. Spinal TB may only occur in around 1–2% of all people with TB.
Tuberculosis spondylitis usually causes back pain, which may sometimes radiate down the legs. People may also experience symptoms of TB, such as:
In people with severe cases, symptoms may also include:
Tuberculous spondylitis occurs due to an infection with the Mycobacterium tuberculosis bacteria.
The bacteria can pass from one person to another if a person with an active TB infection spreads droplets in the air, such as through sneezing or coughing.
Prolonged exposure to people with an active TB infection may increase the risk of people contracting TB.
People with a weakened immune system have a higher risk of TB. This may include people with HIV, people who misuse alcohol or drugs, or those taking medications to suppress the immune system.
Other risk factors for TB include:
The TB bacteria thrive in oxygen-rich environments and can spread through the bloodstream from the lungs to reach the spine.
To diagnose tuberculous spondylitis, a doctor may conduct tests to check for TB infection and get imaging scans to examine the spine.
Tests for TB may include a skin test and blood tests. The tuberculosis skin test is an injection of fluid called tuberculin into the skin of the arm.
People wait 48–72 hours to see if there is a reaction on the arm. The TB skin test indicates that the person has been exposed to TB but does not differentiate past from current infection.
Blood tests, or interferon-gamma release assays (IGRAs), can also show whether a person has a TB infection present.
To check if TB is affecting the spine, a doctor may use:
Tuberculous spondylitis most commonly affects the thoracic spine, the middle part of the spine.
The main treatment for spinal TB is chemotherapy. Treatment with multiple drugs is essential in treating any drug-resistant bacteria.
People may need to continue treatment for 6 months or more. Some recommendations include a regime of 9–12 months. The regime may include months of taking four or five different drugs, such as:
People follow this up with a period of taking two drugs, such as isoniazid and rifampicin.
If first-line medications are not effective, other drugs may include:
Some people may also require additional surgery if:
Depending on the severity of the condition, surgery may aim to:
Early diagnosis and treatment can help achieve a positive outcome with tuberculous spondylitis.
The outlook may depend on the severity of the condition and symptoms. Tuberculous spondylitis with complications, such as deformity, instability, and neurological deficits, may have a less positive outlook.
Other factors affecting outlook can include a person's age, overall health, immune system health, and response to drug therapies.
Minimally invasive surgery may provide excellent outcomes for tuberculous spondylitis.
Tuberculous spondylitis is a type of TB that affects the spine. People may experience back pain and other symptoms of TB infection, such as fatigue, fever, weight loss, and appetite loss.
Treatments for tuberculous spondylitis may include multi-drug treatments and, for some people, surgery.
How Serious Is Tuberculosis?
Without a correct diagnosis and treatment, tuberculosis can sometimes be a serious, potentially life threatening infection. However, with the right steps, it is curable.
Tuberculosis (TB) is a potentially serious bacterial infection that can affect your lungs and other parts of your body. It's spread through droplets when someone with TB talks, coughs, or sneezes.
TB can be asymptomatic, so it's possible to have the infection and not even know it. In some cases, TB mimics mild, cold-like symptoms, which can delay or prevent people from seeking care.
Even though TB is curable, without a correct diagnosis and treatment, TB can progress to a more serious, life threatening infection.
Here's what to know to protect your health.
With active TB, the bacteria multiply and attack the body. TB infection primarily affects the lungs but can also spread to other parts of the body, such as:
When active TB spreads, it increases your risk of additional health problems and can even be life threatening. Certain people, including babies or young children and those with a compromised immune system, have a higher risk of developing active TB than the general population.
A 2014 study found that, even after successful TB treatment, people who had the infection lost an average of 3.6 years of life expectancy compared to those who never had TB. Findings from a 2020 study note that, without treatment, TB can take an average of 7 years off of average life expectancy.
Even though TB can reduce longevity, treatment saves lives. Experts credit current treatments with saving over 53 million lives worldwide since 2000. And most people who develop TB go on to live a regular life.
With prompt diagnosis and treatment, the vast majority of TB cases are curable.
Latent TB can be asymptomatic but still requires treatment. A doctor can prescribe antibiotics to help clear the bacteria from your body and prevent it from developing into active TB. You'll need to take medication as prescribed for 6–9 months.
Active TB is also treated with antibiotics. You'll typically need a combination of antibiotics to clear the infection from your body. You'll also need to continue treatment for 6–12 months.
Take any prescribed TB medications exactly as directed. Be sure to complete the entire course, even if you feel fine. Skipping or missing a dose can result in the infection becoming resistant to the medication, making it much harder to treat.
Get the answers to some of the most common questions about TB.
How long does it take to cure tuberculosis?TB is curable, but treatment takes time. That's because TB germs take a long time to clear the body.
Treatment for latent TB may take up to 9 months to complete. Treatment for active TB can take up to 12 months to fully clear the infection.
You need to take medications exactly as prescribed for months at a time, even if you start to feel better quickly. This helps your body clear the infection entirely from your body and prevents it from becoming resistant to treatment.
Can I survive tuberculosis without treatment?Not everyone who develops TB feels sick. However, without the correct treatment, TB can become life threatening for up to two-thirds of people who develop the infection.
Even if you have latent TB, getting treated can prevent it from progressing to active TB and posing serious risks to your health.
Can you get tuberculosis a second time?It is possible to develop TB more than once. Even if you've been cured of TB, you can contract the bacteria again.
Researchers are unclear whether a recurring infection is a relapse of the original TB bacteria or reinfection with a new strain.
If you think you've developed a case of recurring TB, contact a doctor to discuss next steps.
For some, TB can be a serious, potentially life threatening bacterial infection. However, TB is also treatable. Prompt diagnosis and treatment can cure a TB infection.
Talk with a doctor right away if you suspect you may have been exposed to TB. Taking action can help prevent an exposure from developing into active TB and protect your health.
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