RetourProvider-initiated HIV testing is recommended as part of the evaluation of all TB patients and patients in whom the TB disease is suspected. HIV testing is especially important in people with or suspected of having extrapulmonary TB, because of the increased frequency of extrapulmonary involvement in those with immunosuppression. Extrapulmonary TB is considered to be WHO clinical stage 4 HIV disease.
Based on the severity of signs and symptoms, and the likelihood of potential sequelae, the patient may need frequent treatment monitoring or post-treatment follow-up (or both).
Although surgery is sometimes required for diagnosis, it plays little role in the treatment of extrapulmonary TB, being reserved for management of late complications of disease such as hydrocephalus, obstructive uropathy, constrictive pericarditis and neurological involvement from Pott’s disease (spinal TB). For large, fluctuant lymph nodes that appear to be about to drain spontaneously, aspiration or incision and drainage may be beneficial. To prevent further complications and to manage similar situations in a timely manner, clinical monitoring may be needed in selected patients.
Apart from these specific situations, there are no additional recommendations beyond the standard of care. Additional details on treatment monitoring are given in Section 9 of this document.