Symptoms

 Symptoms of Active Pulmonary Tuberculosis (TB)

Primary pulmonary TB (usually occurring in childhood) often has no visible symptoms but the occurrence of an infection can be identified by the development of a tuberculin skin test or interferon-gamma blood test. Enlargement of mediastinal lymph nodes as part of the primary complex can often discharge into or press on a bronchus, causing the distal part of the lung to collapse or narrowing of bronchioles, leading to obstruction or wheeze.

Children with primary TB may present with weight loss and cough or weight loss alone. However, there are no visible symptoms in about half of all children with primary TB.

Post-primary pulmonary TB (occurring in adolescence or adult life) may initially be symptomless and indeed symptoms can take weeks or months to appear after infection, as Mycobacterium tuberculosis is very slow moving so takes time to get to the lungs. Cough is the most common respiratory symptom – at first dry and non-productive but may later become productive. A small minority of patients also present with haemoptysis. Chest pain is fairly rare but if it is of a dull, ill-localised nature or peripheral lesions are present, it may be due to inflammation of the pleura. Breathlessness may also occur as the disease progresses but usually only when a significant amount of lung is destroyed or there is a substantial pleural effusion.

"Symptoms of Tuberculosis" image courtesy of Wikimedia Commons under creative commons license: Original image

Symptoms of Active Extrapulmonary TB

In addition to the lungs, TB can affect almost any non-pulmonary site; this could be coincidental with infection at pulmonary, infection at multiple extrapulmonary sites or a combination of both.  Whilst infection at most sites (pulmonary or extrapulmonary) can give rise to systemic symptoms, there are also specific symptoms associated with different sites of infection as outlined below.

Lymph node TB (nearly half of all cases of extrapulmonary TB in England and Wales)

• Nodal enlargement (usually slow and painless but can be painful if rapid)
• Lack of erythema and warmth around infected site – ‘cold abscess’
• Nodes progress from being firm and discrete to matted together and fluctuant due to necrosis
• Superficial ulceration around infection site

Bone and joint TB (10-15% of cases of extrapulmonary TB)

• Pain (commonest symptom in spinal disease)
• Local tenderness
• Gradually increasing kyphosis (in spinal disease)
• Abscesses
• Spinal collapse and subluxation due to extradural abscesses
• Sensory and motor symptoms involving legs and sphincters (if spinal cord is compressed)

Disseminated TB

• Malaise
• Fever
• Anorexia
• Weight loss
• Headache from associated meningitis

Central nervous system TB

• Anorexia
• Malaise
• Headache
• Vomiting
• Altered behaviour
• Decreasing level of conciousness
• Choreoathetosis
• Hemiparesis or monoparesis

Genitourinary TB

• Dysuria, haematuria and nocturia as the disease progresses
• Pain in affected region
• Cystitis symptoms
• Increased frequency of urination (due to reduction in bladder capacity caused by inflammation)
• Proteinuria
• Presence of a palpable mass
• Infertility (in females)
• Menorrhagia or post-menopausal bleeding (in females)

Skin TB

• Scrofuloderma
• Presences of tuberculides
• Panniculitis
• Erythema induratum (Bazin’s disease)

Pericardial TB

• Fever
• Malaise
• Sweats
• Cough
• Weight loss
• Hypotension
• Oedema
• Breathlessness

Gastrointestinal TB

• Right iliac fossa pain (about half of acute onset cases)
• Right iliac fossa mass simulating appendix carcinoma or abscess
• Acute intestinal obstruction (about half of acute onset cases)
• Fever
• Malaise
• Abdominal pain
• Weight Loss
• Abdominal distension
• Vomiting (with bowel involvement)
• Presence of a palpable mass
• Gastrointestinal bleeding