History:



* Pulmonary TB: Typical symptoms of pulmonary TB include a productive cough,

fever, and weight loss. Occasionally, patients may presents 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 involvement is the 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

involved, 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. Hematogeneous 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 breath sounds, especially over the

upper lobes or areas invovled.

* Sign of extrapulmonary TB differ depending on the tissues involved. Signs

may include confusion, coma, neurologic deficit, chorioretinitis,

lymphadenopathy and cutaneous lesions (as described above).

* Postnatal TB is contraced via the airbone route. The most common findings

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 retains many stains after decoloration with

acid-alcohol, which is the basis of acid-fast stains.

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