The challenge of extra-pulmonary TB

While pulmonary tuberculosis (TB) remains the most common form, extra-pulmonary TB (EPTB) presents unique challenges due to its varied manifestations and diagnostic complexities. Addressing EPTB is crucial for comprehensive TB control and effective treatment.

EPTB Overview:

• Hidden Burden: Approximately 20% of TB infections are extra-pulmonary, affecting organs like lymph nodes, brain, gut, eyes, etc., with potential long-term complications due to organ damage.
• Underestimation: EPTB is often undetected or misdiagnosed due to its atypical presentation, leading to a significant underestimation of its prevalence, especially in countries like India with a high TB burden.
• Diagnostic Challenges: Lack of accurate diagnostic tools and awareness among physicians contribute to delayed diagnosis and inappropriate treatment of EPTB cases.

 Challenges in Tackling EPTB:

• Lack of Awareness: There is a lack of awareness about EPTB, even among physicians, and a lack of accurate diagnostic and treatment criteria.
• Data Practices: Specialist departments for each organ, which are the primary centres for EPTB management, have diverse data practices that do not contribute to aggregate numbers for EPTB prevalence.
• Need for Guidelines: The guidelines and practice points for EPTB management, formulated by a group of experts in 2014, have remained dormant and need to be updated with the latest data and experience.

The Need for Research and Action:

• Research Priority: Key aspects of EPTB, including the mechanisms of infection spread and the TB bacterium’s interactions with our organs, remain under-explored and require active research.
• Updating Guidelines: The INDEX-TB guidelines, formulated over a decade ago, need to be updated with the latest data and experience, and should benefit from inputs from a variety of specialized areas of healthcare.
• Bringing EPTB Out of the Shadows: With nearly one in five TB patients having EPTB, it is time to bring EPTB out of the shadows and ensure that those diagnosed can benefit from care.

Recommendations:

• Improved Diagnosis: Developing diagnostic protocols specific to each organ affected by EPTB and updating existing guidelines like INDEX-TB to incorporate multidisciplinary inputs can enhance diagnosis and treatment.
• Data Sharing and Collaboration: Enhancing collaboration between TB departments and specialist organ-specific departments can improve data sharing and patient management, leading to better outcomes.
• Research and Development: Investing in research to understand the immune mechanisms underlying EPTB infection and its persistence can guide the development of targeted therapies and improve patient care.

UPSC Mains Questions:

Discuss the public health challenge of extra-pulmonary tuberculosis (EPTB) in India. What are the factors contributing to its underestimation and what measures can be taken to address this?