infectious diseases
Extrapulmonary Tuberculosis (TB)
Treatment of Extrapulmonary TB
Antibiotics Sometimes corticosteroids Sometimes surgery Drug treatment is the most important modality and follows standard regimens and principles (see First-line drugs for TB ). Six to 9 months of therapy is probably adequate for most sites except the meninges, which require treatment for 9 to 12 months. Drug resistance is a major concern; it is increased by poor adherence, use of too few drugs, and inadequate susceptibility testing. are often used for TB meningitis, but the Centers for Disease Control and Prevention (CDC) no longer recommends corticosteroids for TB pericarditis that is not constrictive; however, corticosteroids may prevent constriction in patients who are at risk. Corticosteroids may be used for meningitis and TB pericarditis (even when not constrictive) in patients with Immune reconstitution inflammatory syndrome (IRIS) . Surgeryis required for the following: To drain empyema, cardiac tamponade, or central nervous system abscess To close bronchopleural fistulas To resect infected bowel To decompress spinal cord encroachment Surgical debridement is sometimes needed in Pott disease to correct spinal deformities or to relieve cord compression if there are neurologic deficits or pain persists; fixation of the vertebral column by bone graft is required in only the most advanced cases. Surgery is usually not necessary for TB lymphadenitis except for diagnostic purposes. 