Tuberculosis symptoms
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Tuberculosis (TB) — Symptoms & Clinical Features
Tuberculosis is caused by Mycobacterium tuberculosis, an aerobic rod transmitted via inhalation of infectious droplet nuclei. Clinical presentation varies by stage and immune status.
1. Primary (Initial) TB
The initial infection is usually asymptomatic, detected only by a positive tuberculin skin test or incidental chest radiograph. When symptomatic, features include:
- Cough (often mild)
- Fever
- Malaise and fatigue
- Weight loss
- Chest pain
- Possible hilar adenopathy on imaging
In some immunocompromised patients, primary infection can be rapidly progressive and fatal, resembling acute bacterial pneumonia with consolidation, hilar lymphadenopathy, and pleural effusion. — Tintinalli's Emergency Medicine
2. Latent TB Infection (LTBI)
- No symptoms — patient is not infectious
- Detected only via tuberculin skin test (TST/Mantoux) or interferon-gamma release assay (IGRA)
- Chest radiograph may show a calcified Ghon lesion or Ranke complex (calcified hilar nodes) as evidence of prior infection — Goldman-Cecil Medicine
3. Reactivation (Secondary / Post-Primary) TB
This is the most clinically recognizable form. Symptoms are typically insidious in onset.
Constitutional ("B") Symptoms
| Symptom | Details |
|---|---|
| Fever | Low-grade, remittent — classically appears late each afternoon then subsides |
| Night sweats | Very characteristic |
| Weight loss / anorexia | Often significant |
| Malaise & fatigue | Generalized |
Pulmonary Symptoms
| Symptom | Details |
|---|---|
| Persistent cough | Initially dry, later productive; may be mucoid then purulent |
| Hemoptysis | Present in ~50% of pulmonary TB cases |
| Dyspnea | As infection spreads |
| Pleuritic chest pain | From pleural extension |
Physical exam is often unremarkable; post-tussive rales may be heard over upper lung zones; amphoric breath sounds can indicate a cavity. — Robbins & Goldman-Cecil
4. Extrapulmonary TB (~20% of active cases)
TB can affect virtually any organ. Key manifestations:
| Site | Features |
|---|---|
| Lymph nodes (most common) | Painless cervical lymphadenopathy (scrofula) |
| Pleura | Cough, pleuritic chest pain, exudative pleural effusion |
| Miliary TB | Fever, weight loss, night sweats ± hepatosplenomegaly, choroidal tubercles on fundoscopy — systemic dissemination |
| Meninges | Tuberculous meningitis |
| Spine | Back pain, bony destruction → Pott's disease |
| Kidneys | Hematuria, sterile pyuria |
| Pericardium | Pericarditis → tamponade or constrictive pericarditis |
| Adrenals | Adrenal insufficiency |
| Genitourinary | Epididymitis, orchitis, prostatitis |
| Abdomen | Abdominal pain, hepatosplenomegaly, peritoneal tubercles |
5. TB in HIV / Immunocompromised Patients
- Manifestations become atypical as immunosuppression worsens
- Less likely to have cavitary disease or sputum-smear positivity
- More likely to develop disseminated / miliary infection
- Chest radiograph may appear normal despite active smear-positive disease — CT is more sensitive — Goldman-Cecil Medicine
Key Radiographic Correlates
- Reactivation: Cavitary disease at apical/posterior segments of upper lobes
- Progressive primary: Dense consolidation, middle/lower lobe predominance
- Miliary: Classic 1–2 mm millet-seed nodules throughout lungs (seen in ~85%)
- Old healed TB: Calcified Ghon lesion, fibrotic scars, pleural capping
Classic "Red Flag" Triad in ED
Hemoptysis + night sweats + weight loss — strongly suggests tuberculosis and warrants immediate respiratory isolation and investigation. — Tintinalli's Emergency Medicine
Sources: Robbins & Kumar Pathologic Basis of Disease; Goldman-Cecil Medicine; Tintinalli's Emergency Medicine; Textbook of Family Medicine 9e
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