6.4.2 Severe extrapulmonary TB

A longer treatment regimen may be more suitable in cases of severe extrapulmonary TB, owing to the high risk of negative outcomes including relapse. All such cases have in common the dispersion of M. tuberculosis through blood. Severe extrapulmonary TB is associated with lesions in multiple organs, potentially leading to multiorgan failure. This is more frequently suffered by patients with frank or relative immunosuppression (People with HIV, children, pregnant people, older people, people with cancer, those with solid organ transplants, those on immunosuppressive medication and people with uncontrolled diabetes mellitus). The potential reasons for immunosuppression should be addressed and all potential complications managed. Corticosteroids should be considered case by case, but are recommended in TB meningitis and pericardial TB to reduce complications and disability.

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