Tuberculosis (TB) Part II

CLINICAL

History:

* Pulmonary TB: Typical symptoms of pulmonary TB include a productive cough,
fever, and weight loss. Occasionally, patients may presents with hemoptysis or
chest pain. Other systemic symptoms include anorexia, fatigue, or night
sweats.

* Tuberculous meningitis: Patients may present with a headache that is
either intermittent or persistent for 2-3 weeks. Subtle mental status changes
may progress to coma over a period of days to weeks. Fever may be low-grade or
absent.

* Skeletal TB: The most common site of a involvement is the spine (Pott
disease). Symptoms include back pain or stiffness. Lower extremity paralysis
occurs in as many as half the patients with undiagnosed Pott disease.
Tuberculous arthritis usually involves only 1 joint. Although any point may be
involved, the hip of the knee is affected most commonly, followed by the
ankle, elbow, wrist, hip or the knee is affected most commonly, followed
by the ankle, elbow wrist and shoulder. Pain may precede radiographic changes
by weeks to months.

* Genitourinary TB: Reported symptoms include flank, pain, dysuria, or
frequency. In men, genital TB may present as epididymitis or a scrotal mass.
In women, genital Tb may mimic pelvic inflammatory disease. TB causes
approximately 10% of sterility in women worldwide and approximately 1% in
industrialized countries.

* Gastrointestinal TB: Any site along the gastrointestinal tract may become
infected. Symptoms are ferable to the site infected, to include the following:
nonhealing ulcers of the mouth or anus; difficulty swallowing with esophageal
disease; abdominal pain mimicking peptic ulcer disease with stomach or
duodenal infection; malabsorption with infection of the small intestine; and
pain, diarrhea, hematochezia with infection of the colon.

* Tuberculosis lymphadenitis (scrofula): The most common site is in the neck
along the sternocleidomastoid muscle. It usually is unilateral. It usually is
unilateral, with little or no pain. Advanced disease may suppurate and form a
draining sinus.

* Cutaneous TB: Direct inoculation may result in an ulcer or wartlike
lesion. Contiguous spread from an infected lymph node typically results in a
draining sinus. Hematogeneous spread may result in a reddish brown plaque on
the face or extremities (lupus vulgaris) or tender nodules or abscesses.

Physical: Finding upon physical examination depend on the organs
involved.

* Patient with pulmonary TB have abnormal breath sounds, especially over the
upper lobes or areas invovled.

* Sign of extrapulmonary TB differ depending on the tissues involved. Signs
may include confusion, coma, neurologic deficit, chorioretinitis,
lymphadenopathy and cutaneous lesions (as described above).

* Postnatal TB is contraced via the airbone route. The most common findings
are adenopathy and a lung infiltrate. However, the chest radiography findings
can be normal in infants with disseminated disease. Many experts increase
treatment time to 9 or 12 months because of the possible impaired immune
system in children younger than 12 months. Bacille Calmette-Guerin vaccine is
no longer recommended for infants.

* Causes: M tuberculosis is a slow-growing organism, requiring 4-8 weeks
for visible growth on solid medium. The organism grows in parallel groups called
cords (see Image 1). It retains many stains after decoloration with
acid-alcohol, which is the basis of acid-fast stains.

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© Dr. D.S. Merchant Resident Medicine AKUH
Gold Medalist (Anatomy & Histology)
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