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Clinical manifestations and complications of pulmonary tuberculosis

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


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.)


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, arthralgia, and pharyngitis. (See "Tuberculous pleural effusion".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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