On World Tuberculosis Day, doctors and global health experts are urging a broader understanding of the disease, one that goes beyond its impact on the lungs.
While tuberculosis is often associated with chronic cough and lung infection, nearly 15–20 per cent of cases in India are extrapulmonary, affecting other parts of the body such as lymph nodes, pleura, bones, and joints. Among these, spinal tuberculosis remains one of the most serious yet underdiagnosed forms, often mistaken for routine orthopaedic issues.
A five-year retrospective analysis of extrapulmonary TB cases shows that lymph node TB accounts for nearly one-third of cases, followed by pleural TB, while a smaller but significant proportion involves bones and joints. These forms are harder to detect early because their symptoms are less specific and often misleading. Orthopaedic specialists warn that spinal TB frequently begins like a common complaint.
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“Back pain is one of the most common reasons patients visit an orthopaedic clinic, and most cases are mechanical or lifestyle-related. In India, where TB remains a major public health concern, nearly 15–20% of cases are extrapulmonary, affecting areas beyond the lungs, including the musculoskeletal system, where the spine is among the more serious sites of involvement,” says Dr Simon Thomas, senior director, robotic joint replacements and orthopaedics at Max Super Speciality Hospital, Shalimar Bagh.
He adds that spinal TB tends to present quietly. “It is often only when pain persists despite rest or standard treatment, or when it is accompanied by subtle systemic signs such as fatigue or low-grade fever, that the possibility of an underlying infection is considered. By then, in some patients, the disease may have already progressed to a stage where structural damage has begun.”
If left untreated, spinal TB can gradually destroy vertebrae, leading to deformities such as kyphosis, that is, forward curvature of the spine. In advanced stages, it can compress the spinal cord, causing nerve damage, limb weakness, or even paralysis.
What are the symptoms of orthopaedic TB?
One of the biggest challenges with orthopaedic TB is how easily it slips under the radar. Symptoms include persistent back pain lasting more than two to three weeks, stiffness that does not improve with rest, low-grade fever, especially in the evening, and unexplained fatigue or weight loss.
When joints such as the hips or knees are affected, patients may experience pain while walking, swelling, and reduced mobility, often interfering with daily activities.
Certain groups are more vulnerable, including those with weakened immunity, poor nutrition, or those living in overcrowded and poorly ventilated conditions. People with incomplete or untreated TB are also at higher risk of complications.
TB diagnosis
Doctors emphasise that timely diagnosis is critical and often life-changing.
Advanced imaging, such as MRI, can detect spinal TB early, even before visible structural damage occurs. Blood markers like ESR and CRP, along with molecular tests such as GeneXpert or biopsy, help confirm the infection. With early intervention, most patients respond well to anti-tubercular therapy, significantly reducing the need for surgery.
Even as clinicians call for better awareness of extrapulmonary TB, global health organisations are raising alarm over a different but equally urgent issue, that of children with tuberculosis remaining widely undiagnosed and untreated.
According to the WHO Global Tuberculosis Report 2025, an estimated 1.2 million children under 15 fell ill with TB in 2024, yet 43 per cent were not diagnosed or treated.
TB in children
“This is a disease that is both preventable and treatable, yet children continue to be left behind,” said Cathy Hewison, TB platform lead at Médecins Sans Frontières (MSF). “In an already underfunded TB response, children are pushed further to the back of the line when services are disrupted by aid cuts, conflict or displacement.”
The situation is even more concerning among children under five, where only about half receive a diagnosis and care.
Dr Hewison points out that one of the key barriers is diagnostic difficulty.
Children often do not show classic TB symptoms, and standard laboratory tests may fail to detect the disease.
To address this, the WHO recommends clinical decision algorithms, which allow healthcare providers to diagnose TB based on symptoms and basic investigations, even when lab tests are inconclusive.
“An efficient way to diagnose TB in children under 10 years old is by using WHO-recommended treatment decision algorithms,” Dr Hewison noted, adding that their implementation in several African countries has nearly doubled diagnosis rates.
"In my experience, childhood TB numbers have remained largely steady, but the bigger challenge is underreporting and gaps in contact tracing. Children almost always contract TB from infected adults, so unless cases are properly reported and contacts are traced and treated, they remain at risk. We have strong government guidelines and systems in place, but improving reporting and reducing stigma are critical to breaking transmission,” says Dr Pillarisetti Naveen Saradhi, Consultant Pediatric Pulmonologist, Rainbow Children’s Hospitals, Hyderabad.
Why early detection is the key
Delayed diagnosis can have devastating consequences, especially in children.
Dr Hewison recounts the case of Francisco, an 11-year-old in Mozambique, whose symptoms were overlooked for months. By the time he was diagnosed, he had developed drug-resistant TB.
“At first, I noticed that my child was weak and had no appetite,” said his father, Fernando Jorge Anasomia. “Initially, they didn’t do any tests… It took a long time to start the treatment, even though he started to feel ill eight months ago.”
Stories like these underline a critical gap, not just in access to care, but in recognition of symptoms and timely decision-making.
Experts say tackling TB requires a dual approach, that of better awareness among clinicians and patients, and stronger public health investment, especially for vulnerable populations.
Simple measures such as seeking medical advice for persistent symptoms, ensuring proper nutrition, improving ventilation, and completing TB treatment fully can go a long way in prevention. But on a systemic level, the call is clear that TB can no longer be treated as a single-disease narrative.
Whether it is a lingering backache masking spinal TB, or a child slipping through diagnostic gaps, the message this World TB Day is one of urgency. Recognising the less obvious forms of TB and acting early could mean the difference between recovery and lifelong disability, or even survival.