3.3 Signs and symptoms of Tuberculosis

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The highest priority for TB control is identification and successful treatment of patients who are suffering from smear-positive pulmonary TB.

Pulmonary TB should be presumed in a person who presents with persistent cough for two weeks or more, with or without production of sputum and despite the administration of a broad spectrum antibiotic (without anti TB action). Thus, Presumptive TB refers to a patient who presents with symptoms or signs suggestive of TB.

Often a patient with pulmonary TB has one or more of the following symptoms in addition to cough:

  • Respiratory symptoms: shortness of breath, chest pain, coughing up of blood
  • General symptoms: loss of weight, loss of appetite, fever, night sweats.

GeneXpert or Sputum microscopy should always be requested for patient who has cough for two weeks or longer even in the absence of any other symptoms. Diagnosis of Pulmonary TB should be done using the diagnosis flow chart (Chapter 4).

In addition, contacts of microbiologically confirmed TB Patients, PLHIV, diabetics, malnourished, cancer patients, patients on immune-suppressants or steroid should be regularly screened for sign and symptoms of TB.

The following are also to be investigated as presumptive PTB:

  • Contacts of Microbiologically confirmed TB patients having cough of any duration
  • Presumptive /confirmed extra-pulmonary TB having cough of any duration
  • HIV positive patient having cough of any duration

Presumptive Extra Pulmonary TB refers to the presence of organ-specific symptoms and signs like swelling of lymph node, pain and swelling in joints, neck stiffness, disorientation, etc., and/or constitutional symptoms like significant weight loss, persistent fever for 2 weeks or more, night sweats. Signs and symptoms of extra-pulmonary TB depend on the site involved. Most common examples are:

  • TB lymphadenitis: swelling of lymph nodes
  • Pleural effusion: fever, chest pain, shortness of breath
  • TB arthritis: pain and swelling of joints
  • TB of the spine: radiological findings with or without loss of function
  • Meningitis: headache, fever, stiffness of neck and subsequent mental confusion

The diagnosis of extra-pulmonary TB should always be made by a graduate physician or specialist and often requires special examinations such as GeneXpert incorporated MTB/RIF or ULTRA (EP TB Sample), X-ray, MT, CT scan, MRI, biopsies, Fine Needle Aspiration Cytology (FNAC) etc.