Extrapulmonary Tuberculosis in India: Hidden TB crisis beyond lungs, symptoms, diagnosis challenges you shouldn't ignore

Globally, when the issue of Tuberculosis (TB) is discussed, the focus usually goes to the classic symptoms like a lingering cough or chest pain. However, the situation in India presents a real challenge in terms of the growing complexity of the disease with respect to diagnosing it. TB is not limited to the lungs; it is a multisystem infection capable of affecting nearly every organ in the body. Known as Extrapulmonary Tuberculosis (EPTB), these forms of the disease account for a significant and growing portion of India's TB burden.

According to the WHO Global TB Report 2025, despite India's commendable 21% drop in TB cases since 2015, EPTB accounts for around 20% to 25% of all the cases reported in the country. In some tertiary care hospitals, this percentage can reach 30%-50%, highlighting a dilemma that remains unseen and warrants public health attention.

Why is extrapulmonary tuberculosis hard to diagnose?

According to Dr Amit Kumar Mandal, Senior Director, Pulmonology, Paras Health, Panchkula, "The biggest risk associated with EPTB is its tendency to mimic other diseases, leading to a delay in proper diagnosis. Unlike pulmonary tuberculosis, which is transmitted via airborne droplets, EPTB occurs when the Mycobacterium tuberculosis bacteria spread via the bloodstream or lymphatic system to other parts of the body. The most common presentation in the Indian scenario is lymph node tuberculosis, or tuberculous lymphadenitis. This manifests as painless, slow-growing swellings in the neck."

Recent studies in India show that nearly 33% of all EPTB cases are lymph node-related. These swellings are commonly misinterpreted as mere infection or cyst formation, but if untreated, they can progress to the formation of discharging sinuses. Similarly, abdominal Tuberculosis, which accounts for roughly 8% cases, commonly presents with nonspecific complaints of bloating, changes in bowel habits, and unexplained weight loss, and is commonly misdiagnosed as Crohn's disease or cancer.

How does TB affect bones, spine and brain?

Perhaps the most crippling EPTB is that which involves the skeletal and nervous systems. Spinal TB, or Pott's spine, is one of the leading causes of morbidity in India, representing about 10% of EPTB cases. The condition can cause permanent disability if the vertebrae collapse. Over the years, there has been an increase in such cases, and experts have cautioned that back pain accompanied by fever in the evenings must not be ignored.

Even more critical is Tuberculous Meningitis (TBM), an infection of the brain's lining. It is a medical emergency that can cause seizures, mental confusion, and long-term neurological deficits. Since the symptoms, such as headaches, stiff neck, and sensitivity to light, may be slight at the beginning, the only way to prevent the high mortality rate of this form is early intervention.

Government initiatives to tackle hidden TB cases

India's fight against these hidden forms of TB has gotten a big boost through the significant momentum created by the National Tuberculosis Elimination Programme (NTEP). The government, setting the target of TB elimination by 2025, has facilitated the use of sophisticated molecular diagnostic methods like CB-NAAT (GeneXpert) a nd Truenat, which are much better at detecting EPTB in tissue samples and fluids than conventional microscopy.

Why are awareness and early diagnosis crucial?

Recognising TB beyond the lungs is essential for India to reach its elimination targets. The diagnostic journey for EPTB is often longer and more expensive, but with the Ni-kshay Poshan Yojana now providing increased financial support of 1,000 per month for nutrition, the barrier to treatment adherence is lower than ever.

Awareness is the first line of defence. If someone experiences localised swelling, persistent bone pain, or unexplained abdominal distress alongside a low-grade fever, they must seek specialised screening. In the landscape of modern Indian healthcare, a TB diagnosis is no longer a life sentence, provided we look beyond the chest.

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