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Clinical manifestations of pulmonary tuberculosis

INTRODUCTION

The lungs are the major site for Mycobacterium tuberculosis infection. Pulmonary manifestations of tuberculosis (TB) include primary, reactivation, endobronchial, and lower lung field infection. Complications of TB can also involve the lung, including hemoptysis, pneumothorax, bronchiectasis and, in some cases, extensive pulmonary destruction.

The clinical manifestations of pulmonary TB will be reviewed here. The epidemiology, pathogenesis and treatment of this infection are discussed separately. (See related topics).

PRIMARY TUBERCULOSIS

Primary tuberculosis 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].

Symptoms and signs — The natural history of primary TB was best described in a prospective study of 517 new tuberculin converters living on the Faroe Islands off the coast of Norway from 1932 to 1946 [2]. This study included 331 adults and 186 children, all 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 only 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. Fever was generally low grade but could be as high as 39ºC and lasted for an average of 14 to 21 days. All fever had resolved in 98 percent of patients by 10 weeks.

Symptoms in addition to fever were present only in approximately 25 percent of patients. Chest pain and pleuritic chest pain were most common. One-half of patients with pleuritic chest pain had evidence of a pleural effusion. (See "Tuberculous pleural effusions in non-HIV infected patients" and "Tuberculous pleural effusions in HIV-infected patients".)
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