Beyond the Lungs: The Evolving Face of Tuberculosis
For generations, tuberculosis (TB) has been synonymous with a persistent cough and lung infection. However, a growing understanding of the disease reveals a far more complex picture, with a significant proportion of cases extending beyond the pulmonary system. Doctors and global health experts are increasingly focused on recognizing and addressing these “extrapulmonary” forms of TB, which pose unique diagnostic and treatment challenges.
The Rise of Extrapulmonary TB
In India, approximately 15–20 per cent of TB cases are extrapulmonary, affecting lymph nodes, the pleura, bones and joints. Spinal tuberculosis, in particular, is a serious concern, often initially mistaken for common orthopaedic problems. This misdiagnosis can lead to delayed treatment and potentially devastating consequences.
A recent five-year retrospective analysis highlights the prevalence of different extrapulmonary manifestations. Lymph node TB accounts for roughly one-third of cases, followed by pleural TB, with bone and joint involvement representing a smaller, yet significant, proportion. The difficulty in early detection stems from the non-specific nature of their symptoms.
Spinal TB: A Silent Threat
Back pain is a frequent complaint in orthopaedic clinics, often attributed to mechanical issues or lifestyle factors. However, clinicians are emphasizing the need to consider TB as a potential cause, especially in a country like India where the disease remains a major public health issue. Spinal TB often presents subtly, with pain persisting despite rest or standard treatment. The possibility of infection is often considered only when accompanied by systemic signs like fatigue or low-grade fever – by which point, structural damage may have already begun.
Untreated spinal TB can progressively destroy vertebrae, leading to deformities like kyphosis (forward curvature of the spine). Advanced stages can compress the spinal cord, resulting in nerve damage, limb weakness, or even paralysis.
Recognizing the Symptoms
Orthopaedic TB can be challenging to identify due to its easily overlooked symptoms. Key indicators include persistent back pain lasting more than two to three weeks, stiffness unresponsive to rest, low-grade fever (particularly in the evening), and unexplained fatigue or weight loss. When joints are affected, patients may experience pain during walking, swelling, and reduced mobility.
Individuals with weakened immunity, poor nutrition, or those living in crowded conditions are particularly vulnerable. Those with incomplete or untreated TB are also at higher risk of complications.
The Diagnostic Landscape
Timely diagnosis is crucial. Advanced imaging techniques, such as MRI, can detect spinal TB early, even before structural damage is visible. Blood markers like ESR and CRP, alongside molecular tests like GeneXpert or biopsy, aid confirm the infection. Early intervention with anti-tubercular therapy can significantly reduce the need for surgery.
TB in Children: A Hidden Crisis
While progress is being made in addressing adult TB, a parallel crisis is unfolding among children. According to the WHO Global Tuberculosis Report 2025, an estimated 1.2 million children under 15 fell ill with TB in 2024, yet 43 per cent were not diagnosed or treated. This is particularly concerning for children under five, where the diagnosis rate is only around 50 per cent.
The challenges in diagnosing childhood TB stem from the atypical presentation of symptoms and the limitations of standard laboratory tests. The WHO recommends using clinical decision algorithms to diagnose TB based on symptoms and basic investigations, even when lab tests are inconclusive. Implementation of these algorithms in some African countries has nearly doubled diagnosis rates.
Effective contact tracing and reporting are also critical. Children typically contract TB from infected adults, so identifying and treating these sources of infection is essential to prevent further transmission.
FAQ
Q: What is extrapulmonary TB?
A: TB that affects parts of the body other than the lungs, such as the lymph nodes, pleura, bones, or spine.
Q: Is spinal TB common?
A: It accounts for a significant proportion of extrapulmonary TB cases and can be serious if not diagnosed and treated promptly.
Q: Why is TB difficult to diagnose in children?
A: Children often don’t exhibit classic TB symptoms, and standard tests may not always detect the infection.
Q: What is the best way to diagnose spinal TB?
A: MRI scans are effective at detecting spinal TB early, even before visible damage occurs.
Q: What can be done to prevent TB?
A: Seeking medical advice for persistent symptoms, ensuring proper nutrition, improving ventilation, and completing TB treatment fully are all important preventative measures.
Did you know? Early diagnosis and treatment of TB can significantly reduce the risk of long-term disability and improve patient outcomes.
Pro Tip: If you experience persistent back pain, especially if accompanied by fever or fatigue, consult a doctor to rule out spinal TB.
Learn more about tuberculosis and preventative measures by visiting the World Health Organization’s Tuberculosis page.
Have you or a loved one been affected by TB? Share your story in the comments below.
