Manifestations of Pulmonary Tuberculosis (symptoms, signs)

This article is to discuss the clinical picture of T.B ( manifestations | symptoms and signs ) .
TB is usually classified as pulmonary or extrapulmonary. In absence of HIV infection, it involves the lungs only in > 80% of cases. In presence of HIV, up to 2/3 of patientswith TB have either extrapulmonary disease alone or both pulmonary and extrapulmonary disease.

I- Clinical picture of Primary complex 

(it is often seen in children)
In most cases the primary infection produces no symptoms or signs. Fever, dry cough may occur for 1-2 weeks so, the condition usually passed unnoticed unless the following investigations are done.  :
- Chest x-ray , Sputum examination
- Tuberculin test shows conversion from -ve to +ve
So clinical disease results from the development of hypersensitivity or progression of the primary complex.

(A) Hypersensitivity: to tubercle bacilli may occur leading to:

a- Erythema nodosum       * Bluish red nodule
                                        * Raised
                                        * Tender
                                        * Cutaneous on the skin of tibia
                                        * Tuberculin test is strongly + ve
b- Pleural effusion===> exudative reaction (Hypersensitivity)
c- Phylectinular conjunctivitis.

(B) Progression of primary pulmonary tuberculosis :

- General features of T.B. as night fever and sweating with loss of weight and loss of appetite, Cough, haemoptysis may occur
- lung lesions ==> • Cavity
                            • Pneumonia (especially right middle lobe)
                            • Pleural effusion due to rupture of T.B Cavity into the pleura.

- Bronchial compresion by enlarging lymph nodes ===> Collapse (especially right middle lobe)

- Miliary T.B

- Dissemination

• The lung lesions in primary T.B is usually localized to the middle and lower lung zones.
• The primary T.B may resemble bacterial pneumonia and should be especially suspected with history of close contact to a case of T.B.

II. Post primary T.B.

This occurs due to second exposure or reactivation of primary T.B as mentioned, it may presented by the following:
* General features of T.B. : night fever and sweating,loss of weight and appetite
* Cough, expectoration
* Haemoptysis may result form :
1- Bleeding from vascular tissue granulation
2- Erosion of big vessel traversing a tuberculous cavity
* Manifestations of pneumonia, cavity, milliary T.B. or pleural effusion

The lesion in post primary T.B is usually localized to the apical and posterior segments of the upper lobes.
Important links to related articles
- Pulmonary Tuberculosis def., causes, risks, pathology, types : Here
- Tuberculosis diagnostic investigations and Tuberculin test
Miliary tuberculosis manifestations and investigations
- Complications of pulmonary tuberculosis
Manifestations of Pulmonary Tuberculosis (symptoms, signs)
Dr.Tamer Mobarak


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