Wellness Café

When TB does not look like TB

Mar 2, 2026

When you think of tuberculosis (TB), you think about someone with a bad cough, right? While this is mostly the case, it isn’t the full picture, because the disease can affect areas outside the lungs.

How does extrapulmonary TB happen?

TB is a bacterium that’s spread through the air when active sufferers cough, sneeze, spit, sing or talk.

It’s estimated that around 80% of South Africans are infected with TB. Fortunately, most never get sick (latent TB), but some develop the disease.

In around 15% of cases, the infection spreads to other parts of the body via the blood stream, causing extrapulmonary TB (extra = “outside”, pulmonary = “lungs”). It can affect any organ â from the skin to the spine, brain, lymph nodes, intestines and even the uterus and testes.

Extrapulmonary TB is generally not infectious on its own. But up to 70% of sufferers also have TB of the lungs – and that is contagious.

Are you at risk?

People with weakened immune function are at highest risk of developing extrapulmonary TB. Up to 30 % of HIV patients manifest extra-pulmonary TB. That’s why HIV is the number 1 risk factor in South Africa.

Others include:

Young adults (25 -44 years)
Diabetes
Poor nutrition
Substance abuse
Individual with other immunosuppressive conditions
Women
Immune-suppressive medication

Diagnosis is tricky

Extrapulmonary TB is hard to pick up due to:

Non-specific symptoms: Symptoms are general, such as tiredness, weight loss, and aches and pains that mimic other conditions. You may not even have a cough.
Low awareness: People brush off symptoms, thinking it’s something minor.
Complex testing: Blood tests, scans and even biopsies may be needed.

Treatment works – if you stick to it

With TB, the treatment is sometimes worse than the cure. Very strong antibiotics, taken for at least six months, are needed, and these can make you feel sick. But finishing the treatment is crucial. Stopping too soon can mean that when the infection returns, it is usually resistant to drugs, making it harder to treat.

Reference

National Institute for Communicable Diseases: Extrapulmonary TB

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