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Pulmonary TB
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- Prolonged cough (> 2 weeks), with or without sputum production.
- Weight loss, anorexia, fatigue, shortness of breath, chest pain, moderate fever, night sweats, haemoptysis.
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- Fever and weight loss more common and pronounced.
- Cough and haemoptysis may be less common (less inflammation and cavity formation).
- See algorithm, Chapter 5.
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Disseminated miliary TB
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- 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 on CXR.
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- May be confused with severe wasting in advanced HIV disease.
- M. tuberculosis sometimes isolated from blood cultures.
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Lymph node TB
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- Most often in cervical region.
- Non-inflammatory, painless node > 2 cm, chronic (> 4 weeks); fistulisation possible.
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- 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.
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TB meningitis
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- Subacute, insidious.
- Headache, irritability, fever, altered consciousness.
- Meningeal syndrome usually present.
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- Rule out cryptococcal meningitis: perform antigen test on serum and CSF.
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Bone and joint TB
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- Monoarthitis with joint destruction and little or no pain.
- Deformity of the spine (Pott’s disease).
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- Multifocal disease more common.
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Urogenital TB
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- 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.
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Abdominal TB
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- Ascites (may mask weight loss).
- Abdominal mass, pain, diarrhoea.
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- PTB more frequently associated.
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Effusions
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- Pleural: pleuritic chest pain, dyspnoea.
- Pericardial: chest pain, dyspnoea, lower limb oedema or ascites, pericardial friction rub.
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- Serious effusions are common.
- TB is the most likely aetiology in high TB-HIV prevalence settings.
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