What are the symptoms of tuberculosis (TB)?

Symptoms of Tuberculosis

The most common symptom of pulmonary tuberculosis is persistent cough lasting more than 2-3 weeks, which may or may not produce sputum, and can be accompanied by hemoptysis (coughing up blood), fever, night sweats, and weight loss. 1

Classic Pulmonary TB Symptoms

• Persistent cough for more than 2-3 weeks is the hallmark respiratory symptom, often productive with sputum that may be bloody 1, 2
• Constitutional symptoms include fever, night sweats, weight loss, fatigue, malaise, and failure to thrive (particularly in children) 1, 2
• Additional respiratory symptoms can include chest pain, shortness of breath, and hemoptysis (though hemoptysis is less common) 1, 2
• Important caveat: In the European Union setting, TB is not the leading cause of persistent cough, and cough is not necessarily the most common presenting symptom 1

Extrapulmonary TB Symptoms

• Organ-specific manifestations occur depending on the site of infection, with common sites including lymph nodes, central nervous system, bone, pericardium, peritoneum, and pleura 1
• Pediatric extrapulmonary TB frequently involves lymph nodes, hematogenous spread (miliary TB), CNS, bone, pericardium, peritoneum, and pleura 1

Special Population Variations

Immunocompromised Patients

• May present without specific signs or symptoms of disease, particularly those who are immunosuppressed 1
• HIV-positive patients may have atypical presentations with less specific symptoms, lower lobe infiltrates rather than classic upper lobe involvement, and acute pneumonia-like presentations with nonspecific radiological opacities without hilar adenopathy 1, 2

Elderly Patients

• Less likely to present with fever, sweating, and hemoptysis 2
• More likely to have lower lung lesions and less likely to have cavitary disease 2

Pediatric Patients

• Often have minimal or no symptoms when pulmonary TB is present 1
• Nonspecific symptoms such as weight loss, fever, failure to thrive, and inadequate feeding are common 1
• Congenital TB presents with inadequate feeding, failure to gain weight, upper respiratory symptoms, progressive hepatosplenomegaly, fever, progressive pneumonia, and potentially meningitis 1
• TB in a child is always a "sentinel event" indicating recent transmission, with a source case likely existing in the family or close contacts 1

Clinical Pearls

• Maintain high index of suspicion for TB in patients with persistent cough for more than 2-3 weeks, especially when accompanied by constitutional symptoms 2
• Consider risk factors: history of TB exposure, previous TB diagnosis or treatment, family history of TB, immunosuppressive conditions, immigration from high-prevalence areas, HIV infection, homelessness, or previous incarceration 1, 2
• Respiratory symptoms overlap with many other conditions including acute respiratory infections and COPD exacerbations, requiring careful evaluation 1
• The strength of immune response affects symptom manifestation, with more extensive disease typically presenting with more pronounced symptoms 2