Tuberculosis (TB) Clinical Presentation

Updated: Nov 09, 2017
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Presentation

History

The following factors increase the likelihood that a patient will have tuberculosis (TB):

  • HIV infection
  • History of a positive purified protein derivative (PPD) test result
  • History of prior TB treatment
  • TB exposure
  • Travel to or emigration from an area where TB is endemic
  • Homelessness, shelter-dwelling, incarceration

Classic clinical features associated with active pulmonary TB are as follows:

  • Cough
  • Weight loss/anorexia
  • Fever
  • Night sweats
  • Hemoptysis
  • Chest pain
  • Fatigue

Chest pain in patients with TB can also result from tuberculous acute pericarditis. Pericardial TB can lead to cardiac tamponade or constriction.

Elderly individuals with TB may not display typical signs and symptoms of TB infection, because they may not mount a good immune response. Active TB infection in this age group may manifest as nonresolving pneumonitis.

Signs and symptoms of extrapulmonary TB may be nonspecific. They can include leukocytosis, anemia, and hyponatremia due to the release of ADH (antidiuretic hormone)-like hormone from affected lung tissue.

Tuberculous meningitis

Patients with tuberculous meningitis may present with a headache that has been either intermittent or persistent for 2-3 weeks. Subtle mental status changes may progress to coma over a period of days to weeks. Fever may be low grade or absent.

Skeletal TB

The most common site of skeletal TB involvement is the spine (Pott disease); symptoms include back pain or stiffness. Lower-extremity paralysis occurs in up to half of patients with undiagnosed Pott disease.

Tuberculous arthritis usually involves only 1 joint. Although any joint may be involved, the hips and knees are affected most commonly, followed by the ankle, elbow, wrist, and shoulder. Pain may precede radiographic changes by weeks to months.

Genitourinary TB

Symptoms of genitourinary TB may include flank pain, dysuria, and frequent urination. In men, genital TB may manifest as a painful scrotal mass, prostatitis, orchitis, or epididymitis. In women, genital TB may mimic pelvic inflammatory disease. TB is the cause of approximately 10% of sterility cases in women worldwide and of approximately 1% in industrialized countries.

Go to Tuberculosis of the Genitourinary System and Imaging of Genitourinary Tuberculosis for complete information on these topics.

Gastrointestinal TB

Any site along the gastrointestinal tract may become infected. Symptoms of gastrointestinal TB are referable to the infected site and include the following:

Nonhealing ulcers of the mouth or anus

Difficulty swallowing - With esophageal disease

Abdominal pain mimicking peptic ulcer disease - With stomach or duodenal infection

Malabsorption - With infection of the small intestine

Pain, diarrhea, or hematochezia - With infection of the colon

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Physical Examination

Physical examination findings associated with TB depend on the organs involved. Patients with pulmonary TB have abnormal breath sounds, especially over the upper lobes or involved areas. Rales or bronchial breath signs may be noted, indicating lung consolidation.

Signs of extrapulmonary TB differ according to the tissues involved. They may include the following:

  • Confusion
  • Coma
  • Neurologic defici
  • Lymphadenopathy
  • Cutaneous lesions

Lymphadenopathy in TB occurs as painless swelling of 1 or more lymph nodes. Lymphadenopathy is usually bilateral and typically involves the anterior and posterior cervical chain or supraclavicular nodes.

The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. Up to 20% of patients with active TB may deny symptoms. Therefore, sputum sampling is essential when chest radiographic findings are consistent with TB.

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