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Not Just Your Lungs, Tuberculosis Can Also Affect Other Organs In Your Body: Explained
A Tuberculosis or TB diagnosis can send chills down your spine. However, timely diagnosis can help you manage and treat the disease effectively. Besides understanding the gravity of the illness, it is important to recognise that TB does not only affect your lungs, but also other parts of your body. It can damage different organs and lead to complications. We spoke to two leading experts on the matter.
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What Is Tuberculosis (TB)?
Dr (Col) Vijay Dutta, Senior Consultant, Internal Medicine & Pulmonology, Indian Spinal Injuries Centre, New Delhi, defines tuberculosis as a bacterial infection that mainly affects the lungs. It is caused by a bacterium called Mycobacterium tuberculosis.
According to the World Health Organization (WHO), every year, one crore people fall ill with tuberculosis (TB) and despite being a preventable and curable disease, 10.5 lakh people die from it each year, making it the world's top infectious killer.
Can TB Spread To Other Parts Of The Body"Although TB primarily affects the lungs, it can also affect other organs in the body, leading to extrapulmonary tuberculosis," said Dr Ashish Bajaj, Consultant Microbiologist, Oncquest Pathlabs, Gurugram, adding that it occurs when the bacteria spread from the lungs to other parts of the body through the bloodstream or lymphatic system.
According to Dr Dutta, TB is highly contagious and spreads through the aerosol when an infected person coughs, sneezes, or talks. "People who have poor immune systems due to HIV, cancers and long-term use of systemic steroids are more prone to Tuberculosis. Individuals with underlying medical conditions such as diabetes, or malnutrition are also at higher risk of contracting the disease," he highlighted.
Explaining further, he said, "When the TB bacteria enters the body, the immune system of the host tries to fight the infection by producing white blood cells that engulf the bacteria. However, if the host's immune system is not strong enough, the bacteria can evade the immune system and start multiplying inside the body. Over time, as infected cells die, the bacteria spreads along with them, leading to the formation of small nodules called tubercles. These tubercles can rupture and release the bacteria into the bloodstream, which can ultimately infect other organs in the body. Moreover, TB can also take a toll on other organs of the body by causing a range of symptoms such as fever, weight loss, night sweats, cough and most commonly blood in sputum."
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Other Parts Of The Body TB Can Affect
Extrapulmonary TB can affect various organs and systems, including:
Lymphatic SystemTuberculosis can infect the lymph nodes, causing lymphadenitis. Enlarged lymph nodes, particularly in the neck, are a common manifestation of extrapulmonary TB.
Central Nervous SystemTuberculosis meningitis is a severe form of the disease that affects the membranes surrounding the brain and spinal cord. It can cause symptoms such as severe headache, neck stiffness, fever, confusion, and focal neurological deficits.
Bones and JointsSkeletal tuberculosis, known as Pott's disease, can affect the spine (vertebral tuberculosis), hips, knees, and other joints. It leads to bone destruction, deformities, back pain, and joint inflammation.
Genitourinary SystemTuberculosis can impact the kidneys, causing renal tuberculosis. It may result in symptoms like blood in the urine, flank pain, frequent urination, and urinary tract infections. Genital tuberculosis can also occur, affecting the fallopian tubes, uterus, and other reproductive organs.
Gastrointestinal SystemTuberculosis can affect the gastrointestinal tract, causing gastrointestinal tuberculosis. It may involve the intestines, or peritoneum, leading to symptoms such as abdominal pain, diarrhea, weight loss, and bowel perforation.
Liver and SpleenTuberculosis can infect the liver and spleen, resulting in hepatosplenic tuberculosis. This can cause hepatomegaly (enlarged liver), splenomegaly (enlarged spleen), and liver dysfunction. Pyrexia of unknown origin (PUO), abdominal pain and weight loss are common.
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Symptoms To Beware OfDr Dutta shares a range of symptoms that can arise in advanced stages. These include:
"In advanced cases, if not treated properly it can lead to drug resistance TB. It can affect the brain and spine, causing meningitis or spinal tuberculosis. It can also affect the kidneys, where it forms abscesses that lead to renal failure. TB can even affect the lymph nodes, leading to the formation of tuberculous lymphadenitis," the doctor shared.
Renal Biopsy
Also known as a renal biopsy, a kidney biopsy may be performed if you have abnormal urine or blood tests. There are different types of biopsies using different instrumentation, but all involve an incision and recovery.
A renal biopsy is a procedure used to extract kidney tissue for laboratory analysis. The word "renal" describes the kidneys, so a renal biopsy is also called a kidney biopsy.
The test helps your doctor identify the type of kidney disease you have, how severe it is, and the best treatment for it. A renal biopsy can also be used to monitor the effectiveness of kidney treatments and see if there are any complications following a kidney transplant.
There are two ways to perform a renal biopsy:
A renal biopsy can identify what is interfering with your normal kidney function. Healthy individuals have two kidneys that perform many functions. It's the kidneys' job to:
If your routine blood and urine tests indicate that your kidneys aren't doing their job properly, your doctor may decide to perform a renal biopsy. Your doctor might also order this test to:
Usually, a renal biopsy is performed as an outpatient procedure at a hospital. However, it can also be done in a radiology department if an ultrasound or CT scan is needed during the procedure.
Read on to learn about how these two methods of renal biopsy differ.
Percutaneous biopsiesTypically, a percutaneous biopsy is done by a doctor and takes about an hour.
Just before the procedure, you'll change into a hospital gown. Your doctor might give you a sedative through an intravenous (IV) line in your hand or arm to help you relax. However, you won't receive general anesthesia for this procedure, meaning you'll be awake throughout.
You'll be positioned so that you are lying on your stomach. This keeps your kidneys easily accessible from your back. You may be given a pillow or towel, since you have to remain still and stay in this position for about 30 minutes. If you've already had a kidney transplant, you'll be told to lie on your back.
Next, a doctor will inject a local anesthetic into the entry site to numb the area. They will make a small incision there and insert the needle through the incision and into your kidney. Your doctor might use an ultrasound or a CT scan to direct the needle.
You'll have to take a deep breath and hold it as your physician takes the tissue sample. This may take about 30 to 45 seconds. You may feel some discomfort when the tissue sample is being extracted.
If more than one tissue sample is needed, the process will be repeated several times. Each time, the needle is inserted through the same incision. You'll have to hold your breath while each sample is retrieved.
Types of percutaneous biopsiesThere are actually two types of percutaneous biopsies. The procedure your doctor uses will determine the instrument required to remove the tissue:
After the sample is retrieved, pressure is applied to the biopsy site until any bleeding has stopped. A bandage will be applied over the incision site.
Open biopsiesDepending on your physical condition and medical history, your doctor may recommend an open biopsy. Usually, you have this type of biopsy if you've had problems with bleeding or blood clotting in the past or if you have only one kidney.
If you're having an open biopsy, you'll receive general anesthesia. This means you'll be asleep throughout the procedure. While you're unconscious, your doctor makes an incision and surgically removes a tissue sample from your kidneys. Some surgical biopsies require an incision up to five inches long.
This procedure can also be performed laparoscopically. For this procedure, your doctor will make a small incision and use a laparoscope, which is a thin, lighted tube, to perform the biopsy. The laparoscope has a video camera at the end, which sends images of the kidney to a video monitor. Using a laparoscope, your physician can observe the kidney and extract the larger tissue sample through a smaller incision.
After your renal biopsy, you'll need time for recovery and observation before you're released from the hospital. The timing of your release will vary, depending on your overall physical condition, your doctor's practices, and your reaction to the procedure.
Generally, you'll be taken to a recovery room for rest and observation. During this time, you'll lie on your back — or on your stomach if you've had a kidney transplant — for about six to eight hours.
A nurse or doctor keeps track of your vital signs, including blood pressure, temperature, pulse, and breathing rate. A complete blood count test and urine test is done to see if there is any internal bleeding or other problem. You'll also be given medication to reduce pain at the biopsy site.
When your vital signs are stable, you'll be released from the hospital to go home. This usually happens 12 to 24 hours after the procedure. It's normal to have bright red blood in your urine up to 24 hours after the biopsy. But if this condition lasts more than a day, you should report it to your doctor.
Typically, you can go back to eating your normal diet when you feel hungry. Your doctor may ask that you rest in bed for 12 to 24 hours after your biopsy and avoid strenuous activity and heavy lifting for two weeks.
You should also avoid jogging, aerobics, or any other activity that involves bouncing, for two weeks after your biopsy. You may want to take a pain reliever for any discomfort you have at the biopsy site.
A renal biopsy can provide valuable information that allows your doctor to diagnose kidney abnormalities and decide on appropriate treatments.
Developing an infection after the procedure is a serious risk. However, this rarely occurs. Always be on the lookout for symptoms that could indicate an infection after your renal biopsy. Contact your doctor if you:
In addition to infection, a renal biopsy — like any invasive procedure — carries the risk of potential internal damage to the targeted organ or nearby areas.
Typically, you don't need to do much to prepare for a renal biopsy.
Be sure to tell your doctor about any prescription drugs, over-the-counter medications, and herbal supplements you're taking. You should discuss with them whether you should stop taking them before and during the test, or if you should change the dosage.
Your doctor may provide special instructions if you're taking medications that could affect the results of the renal biopsy. These medications include:
Tell your doctor if you're pregnant or think you might be pregnant. Also, before your renal biopsy, you'll have a blood test and provide a urine sample. This ensures that you don't have any preexisting infections.
You need to fast from food and drink for at least eight hours prior to your kidney biopsy.
If you're given a sedative to take at home before the biopsy, you won't be able to drive yourself to the procedure and need to arrange for transportation.
The tissue sample that was retrieved during your renal biopsy is sent to a laboratory for examination. A pathologist, a doctor who specializes in disease diagnosis, examines the tissue.
Your sample is analyzed under microscopes and with reactive dyes. The pathologist identifies and assesses any deposits or scars that appear. Infections and other abnormal conditions will also be detected.
The pathologist will compile the results and make a report to your doctor. Results are usually ready in about a week.
If the kidney tissue shows a normal structure that is free of deposits and other defects, the results are considered normal.
The results of a renal biopsy are considered abnormal if there are changes in the kidney tissue. There are numerous causes for this result. Sometimes, diseases that begin in other parts of your body can cause damage to the kidneys.
If results are abnormal, it could indicate:
Your doctor may decide to order additional tests to use to help make a treatment plan. They will go over your results and your condition in depth with you and discuss all the next steps following your renal biopsy.
Infected Monkeys At Michigan Research Lab Threaten Health And Science
Monkeys infected with tuberculosis were imported into Michigan earlier this year, sparking a disease investigation by state officials and raising questions from animal rights advocates over national testing shortfalls.
In addition to the monkeys that tested positive for the bacterial infection TB at a West Michigan research facility, there were also two individuals who tested positive, according to the state's Department of Health and Human Services. It is not clear if the infections were related, however, as only 2% of humans at the lab tested positive and typically about 4% of people, some without knowing it, have TB in the general population.
TB is a disease caused by bacteria that can lay dormant in some individuals, and cause serious illness in others. It's a zoonotic disease, meaning it can be transmitted from animal to human, sometimes checked by the immune system for years before causing health problems.
The illness not only poses a potential public health threat, it threatens biomedical research, explained Lisa Jones-Engel, a primate scientist and senior advisor for the group People for the Ethical Treatment of Animals (PETA). An undiagnosed TB infection can skew research data and mislead scientists on the effects of experimental therapies.
"It's scary when you have something that is going to be so deadly to the animals, is a zoonotic threat, can and certainly does represent a scientific threat, and when these animals are co-infected and battling TB infection, anything else they're infected with are more likely to be shed at that point because the animal is sick, its immune system is distracted," Jones-Engel said.
"So it's a mess."
The Michigan Department of Agriculture and Rural Development (MDARD) was alerted early this year of the TB infections in monkeys. At least three macaques wild caught in Mauritius, an Indian Ocean island nation, and imported to Florida and then Michigan were infected, according to an MDARD report obtained by PETA through a Freedom of Information request.
Dr. Jennifer Calogero, assistant state veterinarian for Michigan, said the owner euthanized the infected monkeys, and additional exposed primates were quarantined before being cleared. The state's investigation has since concluded.
The humans who were positive for TB were not experiencing symptoms when tested and were referred for treatment, according to MDHHS. Health officials said it's likely that prompt identification and quarantining of the symptomatic animals may have prevented the potential for transmission to both people and other animals.
According to PETA, the Michigan lab with the TB outbreak was Northern Biomedical Research (NBR) in Norton Shores, which reported having 483 non-human primates in 2020. The state declined to identify the lab, citing a privacy law, and a spokesperson for the lab declined to respond to MLive's questions.
"We do not comment on specific business activities at our facility to protect client confidentiality and employee privacy," reads a company statement. "As a general matter, exposure to TB is a health concern in the federally mandated research and development of critical human treatments and cures."
NBR said it requires negative TB tests as a regular precaution to protect employees and non-human primates from disease. It also proactively tests for many zoonotic diseases in its research models to identify and treat any latent infections, and requires staff to use personal protective equipment.
What concerns Jones-Engel most is infected monkeys were cleared from U.S. Centers for Disease Control and Prevention quarantine prior to arriving in Michigan. She said available skin and blood testing can be inadequate in detecting latent TB, allowing for infections to go undetected.
"Those monkeys should never have left CDC quarantine; they should never have been brought into this country with TB," she said.
"This goes back to how poor the tuberculin tests really are for detecting in monkeys. Those animals in that room who were there with the three original positive animals, all five of those could go through their testing and come out clean and go back on their experimental study and then a month or two months later when the animals are more fully immunosuppressed, they could pop up positive."
In a 2021 paper, JoAnn Yee from the University of California National Primate Research Center wrote that while the CDC continues to require a series of negative tuberculin skin test results for monkeys to clear import quarantine, "there are multiple documented cases of animals successfully clearing quarantine and then later developing clinical disease after shipment to other facilities, often after having been enrolled in a research study."
Monkeys can be imported to the U.S. For three reasons: education, exhibition, and science. The leading exporters of monkeys to the U.S. Include Cambodia and Mauritius.
In 2021, there were more than 30,000 monkeys imported into the U.S. Of those shipments, six had monkeys with positive tuberculin skin tests for TB – the most in any year since 2009 – resulting in 24 monkeys being euthanized over suspicion of TB, according to records obtained by PETA through a Freedom of Information Act request and shared with MLive.
TB can attack the lungs, kidney, spine and brain. It's spread through the air and once it settles in a person's lungs it can move through the blood to other parts of the body.
Some people who are infected have a latent form of TB, meaning they don't get sick or exhibit any noticeable symptoms. They can't spread the bacteria, according to the CDC, and are likely unaware they've been infected.
Others can develop symptoms including a bad cough, chest pain, weakness or fatigue, weight loss, lack of appetite, chills, and fever. If left untreated, the disease can lead to organ failure and become deadly.
Latent TB can develop into TB disease as well. That development is more common in people with weakened immune systems from conditions like HIV, kidney disease, diabetes, or some types of cancer.
Last year, Michigan reported 120 positive cases of TB in humans, or about 1.2 cases per 100,000 people. That marked a 12% decrease from 2021 and was on-par with the state's five-year average.
TB disease can be treated through a combination of drugs taken for 6 to 12 months. There's a vaccine known as BCG, but it's not among the typically recommended shots in the U.S., according to the CDC.
Jones-Engel and her PETA colleagues want to see the CDC suspend importation of primates for use in labs and/or revise its requirements for screening imported primates.
A recent audit by the Government Accounting Office, mandated by U.S. Congress, determined the CDC's current approach in regulating certain imported wildlife species may not be sufficient to prevent outbreaks.
"If CDC comprehensively assessed disease risks to inform decisions about regulating imported wildlife, it could help prevent the introduction of zoonotic diseases into the U.S," reads the report.
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