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 paratracheal lymphadenopathy.• 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 erythema nodosum due to

hypersensitivity reaction to the infective proves.

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.

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

– Tuberculous meningitis• 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.

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 erythema nodosum due to

hypersensitivity reaction to infection