Tuberculosis of the Genitourinary System
Tuberculosis of the Genitourinary System
Tuberculosis (TB) is a deadly infectious disease. Pulmonary TB cases have decreased; yet, extrapulmonary cases such as genitourinary TB have not (Centers for Disease Control and Prevention, 2005). Health care awareness of the clinical features of genitourinary TB is necessary to effectively treat patients with this disease.
Once considered a disease of the past, tuberculosis (TB), also known as "the great imitator," remains one of the most deadly infectious diseases in the world today. Worldwide, 15 to 20 million people have TB of whom 8 to 10 million are infectious (Dirks, Re muzzi, Horton, Schieppati, & Rizvi, 2006). With one-third of the world's population currently harboring latent mycobacterium tuberculosis infection, the World Health Organization (WHO, 2005) reports that the global epidemic is growing by 3% to 4% in Africa each year. TB accounts for 3 million deaths each year; the highest number of deaths related to an infectious disease (Centers for Disease Control and Prevention [CDC], 2005). Although, TB is most prevalent in developing countries, the incidence is highest in persons emigrating from Mexico or from Asian, Middle Eastern, and African countries (Soliman, Lessnau, & Hashmat, 2006). With international travel and the number of foreign-born persons living within the United States, the estimates are burgeoning near 15 million infected individuals in the United States alone (Gibson, Puckett, & Shelly, 2004).
Genitourinary TB is commonly a late manifestation of an earlier symptomatic or asymptomatic pulmonary TB infection (Pasternak & Rubin, 2001). A latency period ranging from 5 to 40 years between the time of the initial infection and the expression of genitourinary TB frequently occurs (Gibson et al., 2004). As one of the most common sites of involvement of extrapulmonary TB, genitourinary TB accounts for 15% to 20% of the infections outside of the lungs (Anwar & Azher, 2002). Overall, worldwide 20% to 73% of extrapulmonary TB is genitourinary and found in the urine of 15% to 20% of the individuals infected with TB (Soliman et al., 2006). While the development of effective interventions has de creased the incidence of pulmonary TB, the number of extrapulmonary cases has shown little change (CDC, 2005). In 1975, the CDC added extrapulmonary TB to their reportable data collection forms; up until that time, the reportable TB information was limited to the total number of TB cases (Leder & Low, 1979). Now with a rise in extrapulmonary cases, exploring the factors that account for this increase is a necessity to combat global TB (CDC, 2005).
For the health care professional, an awareness of atypical acute and chronic urologic disease should warrant the active inclusion of TB. Utilizing evidence-based decision making to identify the occult and insidious form of genitourinary TB may prevent the progressive destruction of the kidney (Peces, de la Torre, AlcE1zar, Tejada, & Gago, 1998). The question remains: For the health care professional, what clinical features of a client with a history of TB exposure, infection, or disease are most significant for suspecting genitourinary TB, and what diagnosis and best practices are used to prevent long-term sequelae? Evidence-based practice guidelines necessary to understand genitourinary TB and its treatment will be presented.
Tuberculosis (TB) is a deadly infectious disease. Pulmonary TB cases have decreased; yet, extrapulmonary cases such as genitourinary TB have not (Centers for Disease Control and Prevention, 2005). Health care awareness of the clinical features of genitourinary TB is necessary to effectively treat patients with this disease.
Once considered a disease of the past, tuberculosis (TB), also known as "the great imitator," remains one of the most deadly infectious diseases in the world today. Worldwide, 15 to 20 million people have TB of whom 8 to 10 million are infectious (Dirks, Re muzzi, Horton, Schieppati, & Rizvi, 2006). With one-third of the world's population currently harboring latent mycobacterium tuberculosis infection, the World Health Organization (WHO, 2005) reports that the global epidemic is growing by 3% to 4% in Africa each year. TB accounts for 3 million deaths each year; the highest number of deaths related to an infectious disease (Centers for Disease Control and Prevention [CDC], 2005). Although, TB is most prevalent in developing countries, the incidence is highest in persons emigrating from Mexico or from Asian, Middle Eastern, and African countries (Soliman, Lessnau, & Hashmat, 2006). With international travel and the number of foreign-born persons living within the United States, the estimates are burgeoning near 15 million infected individuals in the United States alone (Gibson, Puckett, & Shelly, 2004).
Genitourinary TB is commonly a late manifestation of an earlier symptomatic or asymptomatic pulmonary TB infection (Pasternak & Rubin, 2001). A latency period ranging from 5 to 40 years between the time of the initial infection and the expression of genitourinary TB frequently occurs (Gibson et al., 2004). As one of the most common sites of involvement of extrapulmonary TB, genitourinary TB accounts for 15% to 20% of the infections outside of the lungs (Anwar & Azher, 2002). Overall, worldwide 20% to 73% of extrapulmonary TB is genitourinary and found in the urine of 15% to 20% of the individuals infected with TB (Soliman et al., 2006). While the development of effective interventions has de creased the incidence of pulmonary TB, the number of extrapulmonary cases has shown little change (CDC, 2005). In 1975, the CDC added extrapulmonary TB to their reportable data collection forms; up until that time, the reportable TB information was limited to the total number of TB cases (Leder & Low, 1979). Now with a rise in extrapulmonary cases, exploring the factors that account for this increase is a necessity to combat global TB (CDC, 2005).
For the health care professional, an awareness of atypical acute and chronic urologic disease should warrant the active inclusion of TB. Utilizing evidence-based decision making to identify the occult and insidious form of genitourinary TB may prevent the progressive destruction of the kidney (Peces, de la Torre, AlcE1zar, Tejada, & Gago, 1998). The question remains: For the health care professional, what clinical features of a client with a history of TB exposure, infection, or disease are most significant for suspecting genitourinary TB, and what diagnosis and best practices are used to prevent long-term sequelae? Evidence-based practice guidelines necessary to understand genitourinary TB and its treatment will be presented.
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