Clinical Manifestations of TB

1. Clinical Manifestations of TB • Pulmonary disease • Primary disease • Occurs soon after the initial infection in areas of high TB transmission, often in children. • Generally spreads to the upper zones of the lung • The lesion which is formed after infection is usually peripheral and is often accompanied by hilar or paratracheallymphadenopathy. • The initial lesion heals spontaneously in the majority of cases and may later be seen as a small calcified nodule (Ghon lesion) • However in children and immunocompromised people, the lesion can increase in size and result in either a pleural effusion due to infiltration of bacteria into the pleural space, or the primary site may rapidly enlarge causing central necrosis and cavitation. • Enlarged lymph nodes may compress bronchi, creating obstruction and hence segmental or lobar collapse. • This presents generally with fever, malaise, cough, weight loss and haemoptysis. • There may also be a small pleural effusion or erythemanodosum due to hypersensitivity reaction to the infective proves.

2. Clinical Manifestations of TB • Pulmonary disease • Post-primary • Also known as reactivation TB, this results from endogenous reactivation of latent TB. • This also favours the upper zones. • Typically there is a gradual onset of symptoms over weeks to months. • Presents with lethargy, malaise, anorexia and loss of weight with a fever and couch. • Sputum may be mucoid, purulent or blood-stained. A pleural effusion or pneumonia may be the presenting feature. • On examination, finger clubbing may be present in advanced disease. Often there are no physical signs in the chest though occasionally persistent crackles can be heard. • Signs of pleural effusion, pneumonia and fibrosis may be seen.

3. Clinical Manifestations of TB • Extrapulmonary disease • Miliary or Disseminated Tuberculosis • Due to haematogenous spread of bacteria and can be due to either primary infection or reactivation. • Nonspecific signs such as fever, night sweats, anorexia, weakness and weight loss are the presenting symptoms. • Eventually liver and spleen enlarge and tubercle lesions will appear • Tuberculousmeningitis • Seen most often in children or immunocompromised adults. • Results from haematogenous spread of pulmonary disease. • May present with headache and slight mental changes, weeks of low-grade fever, anorexia, malaise, anorexia and irritability. • May evolve acutely with severe headache, confusion, lethargy, altered sensation and neck rigidity. • Diagnosed via LP and if unrecognised it can be fatal.

4. Clinical Manifestations of TB • Extrapulmonary disease • Cardiac • Pericarditis and pericardial effusions • This can lead to constrictive pericarditis due to fibrosis and calcification an can be fatal. • Eyes • Choroiditis • Genitourinary • Pyuria and haematuria, flank pain, frequency, dysuria, nocturia • GIT • Peritoneal TB causing abdominal pain and GI upset (AFB in ascites). • Skeletal • Vertebral collapse, septic arthritis and osteomyelitis • Skin • Jelly-like nodular rash (lupus vulgaris) and possible erythemanodosum due to hypersensitivity reaction to infection