UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Clinical manifestations and complications of pulmonary tuberculosis

Author
Anton Pozniak, MD, FRCP
Section Editor
C Fordham von Reyn, MD
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

The lungs are the major site for Mycobacterium tuberculosis primary infection and disease. Clinical manifestations of tuberculosis (TB) include primary TB, reactivation TB, laryngeal TB, endobronchial TB, lower lung field TB infection, and tuberculoma. Pulmonary complications of TB can include hemoptysis, pneumothorax, bronchiectasis, extensive pulmonary destruction, malignancy, and chronic pulmonary aspergillosis.

The clinical manifestations and evaluation of pulmonary TB will be reviewed here. The clinical manifestations of pulmonary TB in children and HIV-infected patients are discussed separately, as are the epidemiology, pathogenesis, laboratory diagnosis, and treatment of pulmonary TB. Extrapulmonary and miliary TB are also discussed separately. (See related topics.)

CLINICAL MANIFESTATIONS

Primary tuberculosis — Primary tuberculosis (TB) is a term that describes new tuberculosis infection or active disease in a previously naïve host. Primary TB was considered to be mainly a disease of childhood until the introduction of effective chemotherapy with isoniazid in the 1950s. Many studies since that time have shown an increased frequency in the acquisition of TB in adolescents and adults [1,2].

Symptoms and signs — The natural history of primary TB was well described in a prospective study of 517 new tuberculin converters living on the Faroe Islands off the coast of Norway from 1932 to 1946 [3]. The study included 331 adults and 186 children; all were followed for more than five years. The clinical manifestations of primary TB varied substantially in this population, and symptoms and signs referable to the lungs were present in approximately one-third of patients. Fever was the most common symptom, occurring in 70 percent of 232 patients in whom fever was not a condition for enrollment in the study. The fever onset was generally gradual and low grade but could be as high as 39°C (102.2°F) and lasted for an average of 14 to 21 days. Fever resolved in 98 percent of patients by 10 weeks.

Fever was not usually accompanied by other symptoms, although approximately 25 percent of patients developed pleuritic or retrosternal pain. One-half of patients with pleuritic chest pain had evidence of a pleural effusion. Retrosternal and dull interscapular pain were ascribed to enlarged bronchial lymph nodes and sometimes worsened with swallowing. Rarer symptoms included fatigue, cough, arthralgias, and pharyngitis. (See "Tuberculous pleural effusions in HIV-uninfected patients" and "Tuberculous pleural effusions in HIV-infected patients".)

                             

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Jan 12 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Stead WW, Kerby GR, Schlueter DP, Jordahl CW. The clinical spectrum of primary tuberculosis in adults. Confusion with reinfection in the pathogenesis of chronic tuberculosis. Ann Intern Med 1968; 68:731.
  2. Buckner CB, Walker CW. Radiologic manifestations of adult tuberculosis. J Thorac Imaging 1990; 5:28.
  3. POULSEN A. Some clinical features of tuberculosis. Acta Tuberc Scand 1957; 33:37.
  4. Choyke PL, Sostman HD, Curtis AM, et al. Adult-onset pulmonary tuberculosis. Radiology 1983; 148:357.
  5. Krysl J, Korzeniewska-Kosela M, Müller NL, FitzGerald JM. Radiologic features of pulmonary tuberculosis: an assessment of 188 cases. Can Assoc Radiol J 1994; 45:101.
  6. Khan MA, Kovnat DM, Bachus B, et al. Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult. Am J Med 1977; 62:31.
  7. Wilson RJ, Pillay DG, Sturm AW. Mycobacterium tuberculosis is not an obligate aerobe. J Infect 1999; 38:197.
  8. Goodwin RA, Des Prez RM. Apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and progressive massive fibrosis of the lung. Chest 1983; 83:801.
  9. Barnes PF, Verdegem TD, Vachon LA, et al. Chest roentgenogram in pulmonary tuberculosis. New data on an old test. Chest 1988; 94:316.
  10. Arango L, Brewin AW, Murray JF. The spectrum of tuberculosis as currently seen in a metropolitan hospital. Am Rev Respir Dis 1973; 108:805.
  11. MacGregor RR. A year's experience with tuberculosis in a private urban teaching hospital in the postsanatorium era. Am J Med 1975; 58:221.
  12. Mayock RL, MacGregor RR. Diagnosis, prevention and early therapy of tuberculosis. Dis Mon 1976; 22:1.
  13. Verver S, Bwire R, Borgdorff MW. Screening for pulmonary tuberculosis among immigrants: estimated effect on severity of disease and duration of infectiousness. Int J Tuberc Lung Dis 2001; 5:419.
  14. Miller LG, Asch SM, Yu EI, et al. A population-based survey of tuberculosis symptoms: how atypical are atypical presentations? Clin Infect Dis 2000; 30:293.
  15. Hongguang C, Min L, Shiwen J, et al. Impact of diabetes on clinical presentation and treatment outcome of pulmonary tuberculosis in Beijing. Epidemiol Infect 2015; 143:150.
  16. Oursler KK, Moore RD, Bishai WR, et al. Survival of patients with pulmonary tuberculosis: clinical and molecular epidemiologic factors. Clin Infect Dis 2002; 34:752.
  17. Wood R, Middelkoop K, Myer L, et al. Undiagnosed tuberculosis in a community with high HIV prevalence: implications for tuberculosis control. Am J Respir Crit Care Med 2007; 175:87.
  18. Pérez-Guzmán C, Vargas MH, Torres-Cruz A, Villarreal-Velarde H. Does aging modify pulmonary tuberculosis?: A meta-analytical review. Chest 1999; 116:961.
  19. Mathur P, Sacks L, Auten G, et al. Delayed diagnosis of pulmonary tuberculosis in city hospitals. Arch Intern Med 1994; 154:306.
  20. Bobrowitz ID. Active tuberculosis undiagnosed until autopsy. Am J Med 1982; 72:650.
  21. Breen RA, Leonard O, Perrin FM, et al. How good are systemic symptoms and blood inflammatory markers at detecting individuals with tuberculosis? Int J Tuberc Lung Dis 2008; 12:44.
  22. Lee P, Ho KK. Hyponatremia in pulmonary TB: evidence of ectopic antidiuretic hormone production. Chest 2010; 137:207.
  23. Day JH, Charalambous S, Fielding KL, et al. Screening for tuberculosis prior to isoniazid preventive therapy among HIV-infected gold miners in South Africa. Int J Tuberc Lung Dis 2006; 10:523.
  24. POPPIUS H, THOMANDER K. Segmentary distribution of cavities; a radiologic study of 500 consecutive cases of cavernous pulmonary tuberculosis. Ann Med Intern Fenn 1957; 46:113.
  25. Farman DP, Speir WA Jr. Initial roentgenographic manifestations of bacteriologically proven Mycobacterium tuberculosis. Typical or atypical? Chest 1986; 89:75.
  26. LENTINO W, JACOBSON HG, POPPEL MH. Segmental localization of upper lobe tuberculosis; the rarity of anterior involvement. Am J Roentgenol Radium Ther Nucl Med 1957; 77:1042.
  27. Miller WT, MacGregor RR. Tuberculosis: frequency of unusual radiographic findings. AJR Am J Roentgenol 1978; 130:867.
  28. Woodring JH, Vandiviere HM, Fried AM, et al. Update: the radiographic features of pulmonary tuberculosis. AJR Am J Roentgenol 1986; 146:497.
  29. Marciniuk DD, McNab BD, Martin WT, Hoeppner VH. Detection of pulmonary tuberculosis in patients with a normal chest radiograph. Chest 1999; 115:445.
  30. Im JG, Itoh H, Shim YS, et al. Pulmonary tuberculosis: CT findings--early active disease and sequential change with antituberculous therapy. Radiology 1993; 186:653.
  31. Im JG, Itoh H, Han MC. CT of pulmonary tuberculosis. Semin Ultrasound CT MR 1995; 16:420.
  32. Hoheisel G, Chan BK, Chan CH, et al. Endobronchial tuberculosis: diagnostic features and therapeutic outcome. Respir Med 1994; 88:593.
  33. Salkin D, Cadden AV, Edson RC. The natural history of tuberculous tracheobronchitis. Am Rev Tuberc 1943; 47:351.
  34. Wilson NJ. Bronchoscopic observations in tuberculosis tracheobronchitis: Clinical and pathological correlations. Dis Chest 1945; 11:36.
  35. MacRAE DM, HILTZ JE, QUINLAN JJ. Bronchoscopy in a sanatorium; a review of 522 consecutive bronchoscopies. Am Rev Tuberc 1950; 61:355.
  36. AUERBACH O. Tuberculosis of the trachea and major bronchi. Am Rev Tuberc 1949; 60:604.
  37. Shim YS. Endobronchial tuberculosis. Respirology 1996; 1:95.
  38. Kashyap S, Mohapatra PR, Saini V. Endobronchial tuberculosis. Indian J Chest Dis Allied Sci 2003; 45:247.
  39. LINCOLN EM, HARRIS LC, BOVORNKITTI S, CARRETERO R. The course and prognosis of endobronchial tuberculosis in children. Am Rev Tuberc 1956; 74:246.
  40. Frostad S. Lymph node perforation through the bronchial tree in children with primary tuberculosis. Acta Tuberc Scand 1959; 47:104.
  41. Lee JH, Park SS, Lee DH, et al. Endobronchial tuberculosis. Clinical and bronchoscopic features in 121 cases. Chest 1992; 102:990.
  42. Ip MS, So SY, Lam WK, Mok CK. Endobronchial tuberculosis revisited. Chest 1986; 89:727.
  43. Seiden HS, Thomas P. Endobronchial tuberculosis and its sequelae. Can Med Assoc J 1981; 124:165.
  44. Caglayan S, Coteli I, Acar U, Erkin S. Endobronchial tuberculosis simulating foreign body aspiration. Chest 1989; 95:1164.
  45. Matthews JI, Matarese SL, Carpenter JL. Endobronchial tuberculosis simulating lung cancer. Chest 1984; 86:642.
  46. Van den Brande PM, Van de Mierop F, Verbeken EK, Demedts M. Clinical spectrum of endobronchial tuberculosis in elderly patients. Arch Intern Med 1990; 150:2105.
  47. So SY, Lam WK, Sham MK. Bronchorrhea. A presenting feature of active endobronchial tuberculosis. Chest 1983; 84:635.
  48. Williams DJ, York EL, Nobert EJ, Sproule BJ. Endobronchial tuberculosis presenting as asthma. Chest 1988; 93:836.
  49. Albert RK, Petty TL. Endobronchial tuberculosis progressing to bronchial stenosis. Fiberoptic bronchoscopic manifestations. Chest 1976; 70:537.
  50. Yencha MW, Linfesty R, Blackmon A. Laryngeal tuberculosis. Am J Otolaryngol 2000; 21:122.
  51. Shin JE, Nam SY, Yoo SJ, Kim SY. Changing trends in clinical manifestations of laryngeal tuberculosis. Laryngoscope 2000; 110:1950.
  52. SEGARRA F, SHERMAN DS, RODRIGUEZ-AGUERO J. Lower lung field tuberculosis. Am Rev Respir Dis 1963; 87:37.
  53. Chang SC, Lee PY, Perng RP. Lower lung field tuberculosis. Chest 1987; 91:230.
  54. Parmar MS. Lower lung field tuberculosis. Am Rev Respir Dis 1967; 96:310.
  55. STEELE JD. THE SOLITARY PULMONARY NODULE. REPORT OF A COOPERATIVE STUDY OF RESECTED ASYMPTOMATIC SOLITARY PULMONARY NODULES IN MALES. J Thorac Cardiovasc Surg 1963; 46:21.
  56. Stead WW. Tuberculosis among elderly persons: an outbreak in a nursing home. Ann Intern Med 1981; 94:606.
  57. Johnston H, Reisz G. Changing spectrum of hemoptysis. Underlying causes in 148 patients undergoing diagnostic flexible fiberoptic bronchoscopy. Arch Intern Med 1989; 149:1666.
  58. McGuinness G, Beacher JR, Harkin TJ, et al. Hemoptysis: prospective high-resolution CT/bronchoscopic correlation. Chest 1994; 105:1155.
  59. Conlan AA, Hurwitz SS, Krige L, et al. Massive hemoptysis. Review of 123 cases. J Thorac Cardiovasc Surg 1983; 85:120.
  60. Rasmussen V, Moore WD. Continued observations on hemoptysis. Edinburgh Med J 1869; 15:97.
  61. THOMPSON JR. Mechanisms of fatal pulmonary hemorrhage in tuberculosis. Am J Surg 1955; 89:637.
  62. Ramakantan R, Bandekar VG, Gandhi MS, et al. Massive hemoptysis due to pulmonary tuberculosis: control with bronchial artery embolization. Radiology 1996; 200:691.
  63. Muthuswamy PP, Akbik F, Franklin C, et al. Management of major or massive hemoptysis in active pulmonary tuberculosis by bronchial arterial embolization. Chest 1987; 92:77.
  64. Corey R, Hla KM. Major and massive hemoptysis: reassessment of conservative management. Am J Med Sci 1987; 294:301.
  65. Uflacker R, Kaemmerer A, Picon PD, et al. Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results. Radiology 1985; 157:637.
  66. Bobrowitz ID, Ramakrishna S, Shim YS. Comparison of medical v surgical treatment of major hemoptysis. Arch Intern Med 1983; 143:1343.
  67. Yeoh CB, Hubaytar RT, Ford JM, Wylie RH. Treatment of massive hemorrhage in pulmonary tuberculosis. J Thorac Cardiovasc Surg 1967; 54:503.
  68. Amirana M, Frater R, Tirschwell P, et al. An aggressive surgical approach to significant hemoptysis in patients with pulmonary tuberculosis. Am Rev Respir Dis 1968; 97:187.
  69. Berry FB. Tuberculous pyopneumothorax with pyogenic infection. J Thorac Surg 1932; 2:139.
  70. WILDER RJ, BEACHAM EG, RAVITCH MM. Spontaneous pneumothorax complicating cavitary tuberculosis. J Thorac Cardiovasc Surg 1962; 43:561.
  71. Ihm HJ, Hankins JR, Miller JE, McLaughlin JS. Pneumothorax associated with pulmonary tuberculosis. J Thorac Cardiovasc Surg 1972; 64:211.
  72. Aktoğu S, Yorgancioglu A, Cirak K, et al. Clinical spectrum of pulmonary and pleural tuberculosis: a report of 5,480 cases. Eur Respir J 1996; 9:2031.
  73. Hussain SF, Aziz A, Fatima H. Pneumothorax: a review of 146 adult cases admitted at a university teaching hospital in Pakistan. J Pak Med Assoc 1999; 49:243.
  74. Auerbach O, Lipstein S. Bronchopleural fistulas complication pulmonary tuberculosis. J Thorac Surg 1939; 8:384.
  75. Rilance AB, Gerstl B. Bronchiectasis secondary to puomonary tuberculosis. Am Rev Tuberc 1943; 48:8.
  76. Roberts JC, Blair LG. Bronchiectasis in primary tuberculosis. Lancet 1950; 1:386.
  77. Rosenzweig DY, Stead WW. The role of tuberculosis and other forms of bronchopulmonary necrosis in the pathogenesis of bronchiectasis. Am Rev Respir Dis 1966; 93:769.
  78. COHEN AG. Atelectasis of the right middle lobe resulting from perforation of tuberculous lymph nodes into bronchi in adults. Ann Intern Med 1951; 35:820.
  79. CURTIS JK. The significance of bronchiectasis associated with pulmonary tuberculosis. Am J Med 1957; 22:894.
  80. Brock RC. Post-tuberculous broncho-stenosis and bronchiectasis of the middle lobe. Thorax 1950; 5:5.
  81. Bobrowitz ID, Rodescu D, Marcus H, Abeles H. The destroyed tuberculous lung. Scand J Respir Dis 1974; 55:82.
  82. Palmer PE. Pulmonary tuberculosis--usual and unusual radiographic presentations. Semin Roentgenol 1979; 14:204.
  83. Khan FA, Rehman M, Marcus P, Azueta V. Pulmonary gangrene occurring as a complication of pulmonary tuberculosis. Chest 1980; 77:76.
  84. Lorenz R, Kraman SS. Intracavitary mass in a patient with far-advanced tuberculosis. Chest 1982; 82:91.
  85. Kethireddy S, Light RB, Mirzanejad Y, et al. Mycobacterium tuberculosis septic shock. Chest 2013; 144:474.
  86. Brenner AV, Wang Z, Kleinerman RA, et al. Previous pulmonary diseases and risk of lung cancer in Gansu Province, China. Int J Epidemiol 2001; 30:118.
  87. Falagas ME, Kouranos VD, Athanassa Z, Kopterides P. Tuberculosis and malignancy. QJM 2010; 103:461.
  88. Dentan C, Epaulard O, Seynaeve D, et al. Active tuberculosis and venous thromboembolism: association according to international classification of diseases, ninth revision hospital discharge diagnosis codes. Clin Infect Dis 2014; 58:495.
  89. Heit JA, Melton LJ 3rd, Lohse CM, et al. Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clin Proc 2001; 76:1102.