Tuberculosis (TB) Part 2

CLINICAL

History:

* Pulmonary TB: Typical symptoms of pulmonary TB include a productive cough, fever, and weight loss. Occidentally, patients may present 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 complication is thae 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 implied, 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. Hematogene 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 breathing sounds, especially over the upper lobes or areas invovled.

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

* Postnatal TB is contracted via the airbone route. The most common finds 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 keeps many stains after decoloration with acid-alcohol, which is the basis of acid-fast stains.