1. Forms of extrapulmonary TB.

Form of extrapulmonary TB	Characteristics	Diagnostic specimens and means of collection
Tuberculous meningitis	Tuberculosis of the meninges affects people of all ages but is most common among children and people with untreated HIV infection. In adults, tuberculous meningitis presents with gradual onset of headache, neck stiffness, malaise, and fever, and if untreated can progress to altered sensorium, focal neurological deficits, coma, and death. Young children may present with poor weight gain, low‐grade fever, and listlessness. Infants may present with fever, cough (related to the primary pulmonary infection that occurs before tuberculous meningitis develops), change of consciousness at presentation, bulging anterior fontanel, and seizures (Thwaites 2013). Tuberculous meningitis is sometimes associated with a concurrent cerebral tuberculoma, or, more rarely, a tuberculous abscess	Cerebrospinal fluid, acquired by lumbar puncture with or without radiological guidance; biopsy of tuberculoma, acquired surgically
Pleural tuberculosis, also called TB pleurisy	TB infection of the pleura presents with gradual onset of pleuritic chest pain, shortness of breath, fever, night sweats, and weight loss. Chest X‐ray may demonstrate unilateral or occasionally bilateral pleural effusion. The severity of symptoms is highly variable, with many patients experiencing spontaneous resolution of symptoms, while others may develop severe pleural effusions requiring drainage. Pleuro‐pulmonary tuberculosis, in which parenchymal lung involvement is visible on a chest X‐ray, is associated with higher mortality than isolated pleural infection, which appears to be rarely fatal (Shu 2011)	Pleural fluid; pleural biopsy, which may be performed via thoracoscopy or percutaneously with Abram's needle, with or without ultrasound guidance
Lymph node tuberculosis, also called TB lymphadenitis	Tuberculosis of the lymph nodes may affect one node or a group of nodes, or multiple groups within a chain. Lymph node tuberculosis is relatively more common among children than adults. The most common presentation is of a single, firm, non‐tender enlarged node in the neck, although any lymph node group can be affected. This may be accompanied by fever, weight loss, and night sweats, particularly in people with HIV. Patients with tuberculosis in deep lymph nodes, such as the mediastinal or mesenteric lymph nodes, may present with fever, night sweats, and weight loss, or, more rarely, with symptoms related to compression of adjacent structures. Over time lymph nodes become fluctuant and may discharge via a sinus to the skin or an adjacent viscus. It should be noted that lymphadenopathy may also be seen in other forms of tuberculosis as part of the immune response, but this is not usually caused by direct infection of the lymph nodes	Fine‐needle aspiration of fluid from affected lymph node, with or without radiological guidance; surgical biopsy of superficial lymph nodes; endoscopic biopsy of deep lymph nodes with ultrasound guidance
Bone or joint tuberculosis	Tuberculosis of bones or joints or both causes chronic pain, deformity, and disability, and tuberculosis of the cervical spine can be life‐threatening. The usual presenting symptom is pain. Fever and weight loss, with or without signs of spinal cord compression, may be present. Patients with advanced disease may have severe pain, spinal deformity, paraspinal muscle wasting, and neurological deficit. Children may have failure to thrive and difficulty walking	Aspiration of joint fluid or periarticular abscesses; percutaneous computed tomography‐guided biopsy of lesions is preferred, but some patients may require open biopsy
Genitourinary tuberculosis	Tuberculosis of the genitourinary tract includes renal tuberculosis and tuberculosis of the reproductive system. Renal tuberculosis presents with flank pain, haematuria, and dysuria. Female genital tuberculosis presents with infertility (and may be otherwise asymptomatic), pelvic pain, and vaginal bleeding. Testicular tuberculosis presents with a scrotal mass and infertility	Urine; biopsy of affected organs, acquired under radiological guidance or surgically
Pericardial tuberculosis, also called TB pericarditis	Tuberculosis of the pericardium presents with fever, malaise, night sweats, and weight loss. Chest pain and shortness of breath are also commonly‐experienced symptoms. Pericardial tuberculosis may be associated with pericardial effusion, which can be severe and lead to life‐threatening tamponade. Some patients go on to develop pericardial constriction, which can lead to heart failure and death and may require surgical intervention even after mycobacterial cure	Pericardial fluid acquired by pericardiocentesis; pericardial biopsy, acquired under radiological guidance or surgically
Peritoneal tuberculosis	Tuberculosis of the peritoneum usually presents with pain and abdominal swelling, which may be accompanied by fever, weight loss, and anorexia	Ascitic fluid acquired by paracentesis; peritoneal biopsy (Chow 2002)
Disseminated tuberculosis, also called miliary tuberculosis. It has been proposed that the designation ‘miliary TB' be restricted to disseminated TB with miliary shadows on chest radiograph (Reuter 2009)	Disseminated tuberculosis involves two or more distinctly separate sites. Manifestations may be varied, ranging from acute fulminant disease to non‐specific symptoms of fever, weight loss, and weakness. HIV‐positive people are more likely to have disseminated tuberculosis than HIV‐negative people. In a systematic review of the prevalence of tuberculosis in post mortem evaluations of HIV‐positive people, among adults disseminated tuberculosis was found in 88% of tuberculosis cases and was considered the cause of death in 91% of TB cases (Gupta 2015)	Blood; specimens acquired from affected extrapulmonary sites

Abbreviations: TB: tuberculosis.

We adapted the table from Sharma 2017b.