2.5 Summary of clinical presentations of tuberculosis


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

Site

Clinical presentation

Considerations for HIV infected patients

Pulmonary

  • Prolonged cough (> 2 weeks), sputum production, chest pain, shortness of breath.
  • Haemoptysis
  • Constitutional symptoms often present: fever, night sweats, weight loss, anorexia, fatigue.

Disseminated, miliary TB

  • Non specific symptoms: high fever, headache, weight loss.
  • Deterioration over days to weeks.
  • Simultaneous involvement of multiple organs.
  • High risk of meningitis in children (60- 70%).
  • Miliary TB can be under-diagnosed, as it may be confused with severe wasting in advanced stages of HIV infection.
  • 90% have miliary findings on X-ray.
  • TB can sometimes be isolated from blood cultures in HIV-infected individuals (which rarely is the case in non-HIV individuals).

Lymph nodes

  • Non-painful, non-inflamed lymphade- nopathy (> 4 weeks, > 2 cm).
  • Softening and fistulising to become chronic.
  • Most often in cervical region.
  • Often associated with other TB sites.
  • Lymphadenopathy is relatively common in HIV and can result from HIV infection. In persistent generalized lymphadeno- pathy (PGL), lymph nodes are symmetrical, not tender. Posterior cervical or epi- trochlear nodes are often involved.
  • Other causes of lymphadenopathy are more common: lymphoma, carcino- matous metastases, Kaposi‚Äôs sarcoma.

Meningitis

  • Subacute, developing over days to weeks.
  • Fever, irritability, poor feeding, headaches, behaviour change.
  • Vomiting, neck stiffness and photophobia usually present.
  • Often associated with miliary TB.
  • Often insidious onset compared to other meningitis that can occur with HIV patients.
  • Perform antigen test CrAg LFA (Lateral Flow Assay) on serum and CSF to rule out cryptococcocal meningitis.

Osteoarticular TB

  • Monoarthitis with little or no pain, accompanied by joint destruction.
  • More common in HIV-positive.
  • Multifocal disease is more common.

Spinal TB
(Pott's disease)

  • Deformation of the spine.
  • More common in HIV-positive.

Abdominal TB

  • Ascites (rule out other possible causes)
  • Abdominal mass (25-50% in the right lower quadrant), pain or diarrhoea.
  • Usually fever > 2 weeks.
  • Higher rate of PTB present than in HIV-negative.

Pleural effusion

  • Pleuritic chest pain, dyspnoea.
  • More common in young adults.
  • Serious effusions are common in HIV.

Pericardial effusion

  • Chest pain, dyspnoea, lower limb oedema or ascites, pericardial friction rub.
  • In the presence of a pericardial effusion (in high TB-HIV prevalence areas), TB is often the most likely treatable cause.