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What Are The Different Types Of Tuberculosis?

Tuberculosis (TB) does not only affect the lungs — it can also affect other areas of the body, known as extrapulmonary TB. Types of extrapulmonary TB include gastrointestinal TB, skeletal TB, liver TB, and more.

TB is a disease that occurs due to an infection with Mycobacterium tuberculosis bacteria.

It mostly affects the lungs but can also affect other areas of the body, including the liver, bones, reproductive system, and gastrointestinal tract.

People may have either active TB, which is contagious and causes symptoms, or latent TB, which does not cause symptoms or spread to others.

This article covers the different types of TB, testing for the disease, and more.

TB spreads through breathing in air particles containing the TB bacteria. If a person inhales these particles, TB bacteria enter the lung tissue.

Latent TB occurs if people have TB bacteria within their body, but it is inactive. Latent TB does not cause symptoms and cannot pass on to other people. However, latent TB can become active TB if the immune system weakens.

Active TB causes symptoms and is contagious. Doctors refer to active TB as TB disease. Symptoms of active TB include:

People with a weakened immune system have a higher risk of developing active TB from a TB infection. This is because the immune system is less able to fight the lung infection.

With active TB, the bacteria multiply and spread through the body.

Pulmonary TB affects the lungs. The lungs are the primary site of TB in up to 87 in 100 cases. Pulmonary TB may be latent or active, and around 10 in 100 people develop symptoms.

Around one-third of people may develop respiratory symptoms with pulmonary TB, but prolonged fever is the most common symptom.

Extrapulmonary TB affects organs and tissues outside of the lungs. Extrapulmonary TB accounts for around 15 in 100 of all TB cases.

People with a weakened immune system may develop extrapulmonary TB, such as people with HIV.

TB lymphadenitis

TB lymphadenitis affects the lymph nodes and is the most common form of extrapulmonary TB. Symptoms of TB lymphadenitis include:

enlarged lymph nodes, which may appear as painless lumps on both sides of the head and neck

fever

night sweats

fatigue

Skeletal TB

Skeletal TB is a type of TB that has spread to the bones. Around 10in 100 extrapulmonary TB cases are skeletal TB. The most commonly affected area for skeletal TB is the thoracic spine, which is the middle section of the spine.

Symptoms of skeletal TB include:

pain

weakness or changes in movement and muscle function

other TB symptoms, such as fever and malaise

Miliary TB

Miliary TB is a form of both pulmonary and extrapulmonary TB. Miliary TB appears as millet-seed-like lesions on the lungs and other organs in the body.

Miliary TB may affect the blood, bones, lymphatic system, central nervous system, or organs.

Symptoms of miliary TB depend on which organs it affects, but people can experience general symptoms such as:

weakness

fever

cough

unexplained weight loss

lack of energy

Genitourinary TB

Genitourinary TB affects the genitals, urinary tract, or kidneys. Bladder TB usually occurs after a TB infection in the kidneys.

Genital TB is rare, but in females, it may cause infertility. Genitourinary TB does not usually cause any symptoms.

Liver TB

Liver TB usually affects those with an advanced HIV infection or other immunodeficiency. Liver TB may appear as multiple, small nodules on imaging scans.

Gastrointestinal TB

Gastrointestinal TB affects the gastrointestinal tract. TB is rare in the intestines but more common in the ileocecal area, between the end section of the small intestine and the beginning of the large intestine.

Intestinal TB may share similar symptoms and features with Crohn's disease. Complications include intestinal obstructions and perforations.

TB meningitis

TB meningitis is an infection of the meninges, the membranes covering the spinal cord and brain.

The TB infection may travel from the lungs through the lymph nodes to reach the meninges.

TB meningitis causes symptoms of meningitis, including:

TB peritonitis

Peritoneal TB affects the peritoneum, which is the lining of the abdomen. Peritoneal TB usually occurs alongside other types of abdominal TB. Peritoneal TB may cause ascites, which is a buildup of fluid in the abdomen.

TB pericarditis

TB pericarditis affects the pericardium, which is the membrane surrounding the heart. TB pericarditis affects around 1–2% of people with pulmonary TB.

Symptoms of TB pericarditis include:

Cutaneous TB

Cutaneous TB affects the skin and is a rare form of TB. Around 1–2% of all extrapulmonary TB cases are cutaneous TB. It is more common in people with HIV or other immunodeficiency.

Cutaneous TB can appear as any type of skin lesion, such as:

Tests for TB include the following:

Mantoux tuberculin skin test (TST): A doctor will inject a substance — tuberculin — into the skin on the arm to see if it creates a reaction, which can indicate whether a TB infection is present or not.

Blood tests: Doctors use blood tests known as interferon-gamma release assays (IGRAs) to test whether TB infection is present.

X-ray or CT scan: A doctor may carry out additional imaging scans if they think a TB infection is present in the lungs.

Sputum tests: A sputum test examines mucus that people cough up to see if a TB infection is present.

TB usually affects the lungs but can spread to affect other areas throughout the body. Symptoms may depend on the affected area but can include fatigue, night sweats, and fever.

A doctor may carry out skin and blood tests to check for TB infection and find out the location and type of TB.

Eradicating Deadly Tuberculosis With Better Tests And Treatments

European researchers are tackling the world's most lethal infectious disease as part of efforts to end it by 2035. Dr. Cristina Vilaplana is a medical doctor passionate about helping patients with tuberculosis (TB). Her research could make a difference to a lot of people.

Each year globally, around 10 million adults and children fall ill with TB and 1.6 million people die. This makes it the world's leading infectious-disease killer.

While countries with high TB rates include China, India, Indonesia, Pakistan and the Philippines, Europe also still faces the disease.

"You might think TB is eradicated in Europe, but this is not the case," said Vilaplana, who works at the Germans Trias i Pujol Research Institute, or IGTP, in Barcelona, Spain.

She points to a persistence of high numbers of TB in small pockets—mostly socially deprived communities—across the continent.

Although the disease was temporarily knocked off the top spot by COVID-19, lockdowns and disruptions during the pandemic meant that fewer people were diagnosed and treated for TB than usual, storing up trouble.

In March this year, the World Health Organization (WHO) warned that TB deaths in the European region increased in 2021 compared with 2020. This is the first time in 20 years TB cases have been on the rise, prompting concerns about the feasibility of a goal to end the disease by 2035.

Lasting damage

Like COVID-19, TB is spread through the air from one person to another. People infected with the tuberculosis bacteria can remain symptom-free.

Once the disease takes hold, however, the patient suffers both from the damage caused by the bacteria itself and from the inflammation that results as the body fights back.

Currently, about half of all tuberculosis patients are left with permanent damage. This means that, even when cured of the bacterial infection, they may still have a lasting effect that leaves them struggling to breathe when carrying out daily activities such as walking.

"Patients are cured but don't feel better," Vilaplana said. "I want them to feel better."

The insight led her to test some existing, common anti-inflammatory medications in mice with TB. When the mice were given ibuprofen or aspirin, their lungs suffered less damage.

As a result, the EU-funded SMA-TB project led by Vilaplana is investigating whether these widely available and relatively safe drugs could potentially also help patients with TB recover more fully from the disease.

The project, which began in January 2020, runs through June 2024.

It will feed data from the TB patients into a medical algorithm with the aim of predicting the course of the disease and identifying those people who will respond best to anti-inflammatory drugs. This will help doctors come up with more personalized options for patients to recover better.

Urine, breath tests

Across Europe, researchers are exploring new ways to tackle the disease.

"TB is far from eradicated," said Dr. Jose Dominguez, a tuberculosis researcher who is also based at the IGTP and leads another EU-funded project called INNOVA4TB.

Combining expertise from 16 research institutions in six countries, the initiative is seeking simpler ways of diagnosing TB and groundbreaking treatments for it. The project started in January 2019 and runs through June 2024.

One strand being investigated is finding new biomarkers—a biological indicator of the body's internal condition such as blood pressure or cholesterol levels—to make diagnosis quicker, cheaper and more accessible.

For example, the researchers have discovered tell-tale molecules in urine that are not only able to diagnose the illness but can potentially flag when a person is moving from a sleeping, or "latent," infection to an active one.

This is important because, while people in the transition stage to active TB may not yet have symptoms, they can still be contagious and spread the disease to family and friends.

"If you can identify patients who will suffer from tuberculosis, you could treat them with drugs and avoid progression," said Dominguez.

Work is also underway on ways to diagnose TB simply by testing a person's breath.

These two diagnostic approaches have several advantages over the existing sputum test, which requires patients to cough up mucus from the lungs. For one, they will be less unpleasant for people, especially children, who struggle with the sputum test.

The new tests will also be easy to conduct outside a hospital setting and the results will be available quickly—elements that could be useful in poorer countries and rural regions.

Resistant strains

A worrying development has been the emergence of drug-resistant TB, especially in countries like Moldova and Ukraine.

First-line antibiotics don't work in such cases and the drugs given to patients instead can have serious side effects.

Moreover, it can take 18 months fully to treat drug-resistant forms of the disease.

"Imagine taking pills for one and a half years," said Dominguez. "It is not easy for patients to follow this treatment."

A team of INNOVA4TB researchers is developing and evaluating a test that can tell whether a person is infected with drug-resistant TB within three hours, allowing doctors to start treatment immediately.

Evaluations of the test in different locations are due to start soon in both Europe and India.

Another team is using DNA sequencing to identify and monitor drug-resistant TB strains in Ukraine and Moldova. This will help ensure that treatments offered are the most effective available.

New drugs, deliveries

On the treatment front, the researchers have honed in on the marine environment as a rich source of potential new antimicrobial agents and are working to isolate new strains of Actinobacteria from the Black Sea with a view to developing new treatment options.

The project is also exploring new ways of delivering drugs deeper into the lungs. Traditionally this goal has been challenging because the lungs' natural defense mechanisms work to remove or inactivate anything that appears foreign.

Nanoparticles are emerging as a good vehicle for drug delivery and this area has interesting potential, according to Dominguez.

He said such future treatments could perhaps be delivered via a spray directly to the lungs.

"The project is trying to help both European citizens and worldwide TB patients," said Dominguez.

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We Can Fight Tuberculosis With The Stop TB Now Act

The Journal of the American Medical Association recently posted an article online about the 20-year history of the President's Emergency Plan for AIDS Relief (PEPFAR). It is a story of a devastating disease and what can be done to meet that challenge.

There is a popular phrase in public health circles that people are living with AIDS and dying of tuberculosis, or TB. Much of the health infrastructure for dealing with TB in low-income countries was repurposed for the covid-19 pandemic. As covid-19 mortality rates are declining, TB is re-emerging as the most common cause of death from infectious disease worldwide.

It doesn't have to be that way.

I sincerely hope that more legislators will follow the example of my representative, Rep. Suzan DelBene, to pass HR 1776, the Stop TB Now Act.

Mary Minor

Snohomish

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