What are the common clinical manifestations of tuberculosis (TB)?

Clinical Manifestations of Tuberculosis

All of the above (Option D) is correct—tuberculosis characteristically presents with nonspecific and insidious signs and symptoms, including fever, night sweats, weight loss, anorexia and weakness, and in pulmonary TB, cough that is often initially nonproductive. 1, 2

Nonspecific and Insidious Presentation (Option A)

The clinical presentation of TB varies considerably and is often nonspecific, making diagnosis challenging. 1

• The American Thoracic Society emphasizes that clinical signs of TB infection can be nonspecific, particularly in certain populations such as infants with congenital TB who may present only with inadequate feeding and failure to gain weight. 1
• Children with pulmonary TB might have little or no symptoms, and when present, symptoms are often nonspecific (e.g., weight loss, fever, and failure to thrive). 1
• The insidious nature of TB means that for every person diagnosed with pulmonary TB, an estimated 10 to 100 persons must be evaluated based on clinical criteria alone. 1

Constitutional Symptoms (Option B)

The classic systemic symptoms of TB include fever, night sweats, weight loss, anorexia, and weakness. 1, 2

• The American Thoracic Society identifies these as typical signs and symptoms of TB: prolonged coughing with production of sputum that might be bloody, fever, night sweats, and weight loss. 1
• These constitutional symptoms reflect the systemic inflammatory response to mycobacterial infection and are present across various forms of TB. 3, 4
• The combination of these symptoms lasting 2-3 weeks or more should trigger evaluation for TB, particularly in high-risk patients. 1, 2

Pulmonary Manifestations (Option C)

In pulmonary TB, cough develops and is characteristically nonproductive initially, later becoming productive with sputum that may be bloody. 1, 2

• The American Thoracic Society recommends evaluating any patient with a cough of 2-3 weeks duration, particularly when accompanied by additional symptoms including fever, night sweats, weight loss, or hemoptysis. 1, 5
• The cough typically progresses from nonproductive to productive over time, with sputum production that might eventually become bloody (hemoptysis). 1, 3
• TB should be suspected in any patient who has persistent cough for more than 2 to 3 weeks or other compatible signs and symptoms. 1, 2

Important Clinical Variations

The clinical presentation varies based on host factors and underlying conditions. 1, 2

• Variation in clinical symptoms and signs of TB is associated with underlying illnesses such as HIV infection, chronic renal failure, alcoholism, drug abuse, and diabetes mellitus. 1
• HIV-infected patients may present with atypical features, including lower lobe infiltrates rather than classic upper lobe involvement, and may have more nonspecific symptoms. 1, 2
• The strength of the patient's immune system affects symptom manifestation, with immunocompromised patients potentially having minimal or atypical symptoms. 2, 4

Critical Clinical Pearls

Maintain a high index of suspicion for TB, especially in high-risk populations, as the nonspecific nature of symptoms can lead to diagnostic delays. 2, 5

• Consider TB in patients with relevant risk factors: exposure to TB, positive TB infection test, immigration from high-prevalence areas, HIV infection, homelessness, or previous incarceration. 1, 2
• The features are not specific for TB—many other conditions can present similarly, requiring systematic evaluation. 1
• Diagnostic delay can lead to increased transmission and worse outcomes, highlighting the importance of prompt recognition. 2, 5