Symptoms of Tuberculosis
The classic symptoms of tuberculosis include persistent cough lasting more than 2-3 weeks (often productive with sputum that might be bloody), fever, night sweats, and weight loss. 1
Pulmonary Tuberculosis Symptoms
Pulmonary TB is the most common form of tuberculosis, accounting for approximately 75% of cases. Key symptoms include:
- Persistent cough lasting more than 2-3 weeks (the most common symptom) 1
- Sputum production that may be bloody (hemoptysis) 1
- Fever 1
- Night sweats 1
- Weight loss 1
- Fatigue 1
- Chest pain 1
- Shortness of breath 1
Variations in Clinical Presentation
The clinical presentation of TB varies considerably based on several factors:
- Disease extent: More extensive disease typically presents with more pronounced symptoms 1
- Host immune response: The strength of the patient's immune system affects symptom manifestation 1
- Underlying conditions: Symptoms may vary in patients with comorbidities 1
Special Populations
Symptom presentation may differ in specific populations:
- HIV-positive patients: May have atypical presentations with less specific symptoms or lower lobe infiltrates on chest radiographs rather than the classic upper lobe involvement 1
- Elderly patients: Less likely to present with fever, sweating, and hemoptysis; more likely to have lower lung lesions and less likely to have cavitary disease 1
- Immunocompromised patients: May have minimal or atypical symptoms 1
Radiographic Findings
While not symptoms per se, radiographic findings often accompany symptomatic TB:
- Classic findings in immunocompetent patients: Upper lobe infiltrates with evidence of contraction fibrosis and cavitation 1
- HIV-positive patients: May show lower lobe and lobar infiltrates, hilar adenopathy, or interstitial infiltrates 1
Extrapulmonary Tuberculosis
TB can affect organs other than the lungs, causing organ-specific symptoms depending on the site of infection 1.
Clinical Pearls and Pitfalls
- High index of suspicion: TB should be suspected in any patient with persistent cough for more than 2-3 weeks, especially if accompanied by other classic symptoms 1
- Symptom variability: Not all patients present with all symptoms; some may even be asymptomatic, particularly those who are immunosuppressed 1, 2
- Common misdiagnosis: TB symptoms can mimic other respiratory conditions like acute respiratory infections or COPD exacerbations 1
- Risk factors: Consider TB in patients with relevant risk factors (exposure to TB, positive TB infection test, immigration from high-prevalence areas, HIV infection, homelessness, previous incarceration) 1
- Diagnostic delay: Failure to recognize symptoms can lead to delayed diagnosis and increased transmission 1
When to Suspect TB
TB should be suspected in patients with:
- Unexplained cough lasting 2 or more weeks 1, 3
- Classic symptom constellation (cough, fever, night sweats, weight loss) 1
- Risk factors for TB plus any respiratory symptoms 1
- Findings suggestive of TB on chest radiographs 3
Remember that while these symptoms are characteristic of TB, they are not specific, and further diagnostic testing is required to confirm the diagnosis 1.