2.5 Summary of clinical presentations of tuberculosis

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    Table 2.3 - Clinical presentations and considerations for HIV-infected patients

     

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    Clinical presentations

    Considerations for HIV patients

    Pulmonary TB

    • Prolonged cough (> 2 weeks), with or without sputum production.
    • Weight loss, anorexia, fatigue, shortness of breath, chest pain, moderate fever, night sweats, haemoptysis.
    • Fever and weight loss are more common and pronounced.
    • Cough and haemoptysis may be less common (less inflammation and cavity formation).
    • See algorithms, Chapter 4.

    Disseminated miliary TB

    • Non-specific symptoms: high fever, headache, weight loss.
    • Deterioration over days or weeks.
    • Simultaneous involvement of multiple organs.
    • High risk of meningitis in children.
    • Miliary findings CXR.
    • May be confused with severe wasting in advanced HIV disease.
    • M. tuberculosis sometimes isolated from blood cultures.

    Lymph nodes TB

    • Most often in cervical region.
    • Non-inflammatory, painless node > 2 cm, chronic (> 4 weeks); fistulisation possible.
    • HIV infection can cause persistent generalised lymphadenopathy (PGL). PGL lymph nodes are painless, and symmetrical. Posterior cervical or epitrochlear nodes are often involved.
    • Other common causes of lymphadenopathy include lymphoma, carcinomatous metastases, Kaposi sarcoma.

    TB meningitis

    • Subacute, insidious.
    • Headaches, irritability, fever, altered mental status.
    • Meningeal syndrome usually present.
    • Rule out cryptococcal meningitis: perform antigen test on serum and CSF.

    Bone and joint TB

    • Monoarthitis with joint destruction and little or no pain.
    • Deformity of the spine (Pott’s disease).
    • Multifocal disease more common.

    Urogenital TB

    • Renal: urinary symptoms, few constitutional symptoms; suspected when no response to antibiotics for urinary infection.
    • Non-specific gynaecological symptoms, infertility or epididymitis with scrotal pain.
     

    Abdominal TB

    • Ascites (may mask weight loss).
    • Abdominal mass, pain, diarrhoea.
    • PTB is more frequently associated.

    Effusions

    • Pleural: pleuritic chest pain, dyspnoea.
    • Pericardial: chest pain, dyspnoea, lower limb oedema or ascites, pericardial friction rub.
    • Serious effusions are common.
    • TB is the most likely aetiology in high TB-HIV prevalence settings.

     

    TB is considered as non-severe if the following criteria are met:

    • negative smear microscopy, and
    • uncomplicated PTB with a small infiltrate confined to one lobe and no cavities, or
    • uncomplicated extra-thoracic lymph node TB, or
    • uncomplicated intrathoracic lymph node TB.