II. Distribution: Areas of Dissemination

  1. Tuberculous Lymphadenitis or Scrofula (most common non-pulmonary form)
    1. Cervical Lymphadenopathy is most common
    2. Swollen and matted nodes that may drain
  2. Pleural Tuberculosis (5%) and Pleural Effusions
  3. Skeletal Tuberculosis (35%)
    1. Thoracic and Lumbar Spine involvement of intervertebral discs and Vertebrae (Pott's Disease)
    2. Chronic Monoarthritis may also occur
  4. Tuberculous Meningitis (with CNS Granulomas)
    1. CSF with moderate Lymphocytosis
  5. Gastrointestinal Tuberculosis
  6. Genitourinary Tuberculosis
  7. Tuberculous Peritonitis
  8. Tuberculous Pericarditis and Pericardial Effusion
  9. Miliary Tuberculosis (Disseminated tuberculosis)
    1. Named for its tiny Millet Seed sized Granulomas widely distributed (similar to shotgun pellets)
    2. Seen in AIDS and untreated Tuberculosis
    3. Presents with fever, Night Sweats, weight loss
    4. PPD is positive in only 50% of cases

III. Management

  1. See Active Tuberculosis
  2. Duration of therapy (phase 1 and 2 combined)
    1. Most forms of Extrapulmonary Tuberculosis: 4-7 months
    2. CNS Tuberculosis: 9-12 months
    3. Musculoskeletal Tuberculosis: Extended duration
  3. Phase 1: First 2 months (altered if suspect resistance)
    1. Isoniazid
    2. Rifampin
    3. Pyrazinamide
    4. Ethambutol
  4. Phase 2: Duration varies per guidelines above
    1. Isoniazid
    2. Rifampin

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