Pulmonary Tuberculosis Symptoms, Signs and Symptoms

Clinical Features Of Pulmonary Tuberculosis

Symptoms primary tuberculosis

1. Evening rise in temperature
2. Night sweats
3. Malaise and cachexia
4. Irritability and difficulty in concentration.
5. Cough and expectoration for more than three weeks.
6. Pleuritic chest pain
7. Breathlessness is a feature of advanced disease.
8. Indigestion and dyspnea
9. Amenorrhea often in young women
10. Hoarseness of voice.
11. Sputum can be mucoid, purulent, or blood-stained.
12. Hemoptysis is a classical feature
13. Presence of localized wheeze from local ulcer or narrowing of major bronchus.
14. Presence of recurrent cold.

Physical signs Primary Tuberculosis

1. Fever and weight loss
2. Tachycardia and tachypnea
3. Rapid pulse rate
4. Physical signs of collapse, consolidation, cavitation, fibrosis, bronchiectasis, pleural effusion, or pneumothorax.
5. In some cases, only localized *rhonchi or rales are present.
6. Clubbing of fingers is present in chronic disease.
7. The most common physical sign of the chest is fine crepitation in the upper part of one or both lungs. This is heard on taking a deep breath after coughing.
8. Later on, there can be the presence of dullness to percussion or bronchial breathing in the upper part of one or both lungs.
9. In chronic cases, there is evidence of volume loss and mediastinal shift.
10. Hilar, mediastinal, and cervical group lymph nodes are enlarged with splenomegaly.

Primary Tuberculosis Pathology

1. The reinfection of a sensitized person or reactivation of a primary dormant lesion is called secondary or postprimary tuberculosis.
2. The initial lesion after ingestion of tubercle bacilli which mainly occurs in the lungs constitutes primary tuberculosis.
3. It commonly involves children and is in the form of subpleural lesions either in the lower part of the upper lobe or the upper part of the lower lobe.
4. The initial entry of the bacilli initiates a non­specific inflammatory response which hardly produces any symptoms. Bacilli are transported to regional lymph nodes and parenchymal lesions in the lungs (Ghon Focus) along with enlarged lymph nodes which may calcify over a period of time and this constitutes the primary complex (Ghon’s complex).
5. A case of primary tuberculosis draws attention when a child may present with nonspecific pneumonia or bronchial obstruction because of the enlarged hilar gland or low-grade fever with pleural effusion.
6. The primary complex heals leaving a calcified lesion.
7. Bacilli may remain for years and may become reactivated when the body’s immunity falls as in malnutrition, debilitating disease, and following severe forms of measles, whooping cough.

Clinical Features Primary Tuberculosis As tuberculosis remains symptom­free and is diagnosed on routine radiography.

Symptoms Primary Tuberculosis

1. Evening rise in temperature
2. Night sweats
3. Malaise and cachexia
4. Irritability and difficulty in concentration.
5. Cough and expectoration for more than three weeks.
6. Pleuritic chest pain
7. Breathlessness is a feature of advanced disease.
8. Indigestion and dyspnea
9. Amenorrhea often in young women
10. Hoarseness of voice.
11. Sputum can be mucoid, purulent, or blood-stained.
12. Hemoptysis is a classical feature
13. Presence of localized wheeze from local ulcer or narrowing of major bronchus.
14. Presence of recurrent cold.

Physical signs Primary Tuberculosis

1. Fever and weight loss
2. Tachycardia and tachypnea
3. Rapid pulse rate
4. Physical signs of collapse, consolidation, cavitation, fibrosis, bronchiectasis, pleural effusion, or pneumothorax.
5. In some cases, only localized *rhonchi or rales are present.
6. Clubbing of fingers is present in chronic disease.
7. The most common physical sign of the chest is fine crepitation in the upper part of one or both lungs. This is heard on taking a deep breath after coughing.
8. Later on, there can be the presence of dullness to percussion or bronchial breathing in the upper part of one or both lungs.
9. In chronic cases, there is evidence of volume loss and mediastinal shift.
10. Hilar, mediastinal, and cervical group lymph nodes are enlarged with splenomegaly.

Investigations Primary Tuberculosis

1. Sputum examination (for acid-fast bacilli): By direct smear examination (Ziehl­Neelsen stain). At least, three smears must be examined before finally reaching a conclusion.
   • When a direct smear is negative, sputum examination is done by concentration method using a 24-hour collection of sputum. Further confirmation is done by sputum culture by animal inoculation which takes 4–8 weeks. If an adequate amount of sputum is not available, bronchoscopic aspiration of secretions is made and submitted for smear and culture examination.
2. Serology: In this ELISA, technique is used which is helpful in the diagnosis of tuberculosis in children. PCR technique is a more specific and sensitive serological test than ELISA, but PCR is less used due to its high cost.
3. Chest X-ray: The presence of multiple nodular infiltrations or ill-defined opacities in one of the upper lobes is characteristic of pulmonary tuberculosis. An area of translucency in radiopacities is indicative of cavitation.
   1. The presence of a cavity is indicative of an active lesion. In some of the patients, multiple thick­walled cavities can be seen. At the time of firosis, the trachea and mediastinum shift to the same side.
   2. Fibrosis can also cause calcification
4. Pathological tests:
5. 1. Blood examination: Peripheral blood examination shows monocytosis, i.e. 8 to 12%
   2. ESR is elevated.
   3. Tuberculin test: It is a test to recognize prior tubercular infection, and is done by injecting one unit of purifid protein derivative (PPD) on the forearm and readings taken after 48 hours.
   4. Induration of more than l5 mm indicates a positive test.
   5. The younger is the patient, greater is signifiance of positive test. A negative test does not always exclude tubercular infection since it may be negative in patients of blood malignancies,malnourishment and those on immunosuppressive therapy.
   6. Tuberculin test is non­specific and only indicates prior infection.
   7. Its sensitivity wanes with age.

Clinical Features And Evaluate Management Of Postprimary Tuberculosis

Postprimary tuberculosis is also known as secondary tuberculosis. Most of the morbidity and mortality from TB is caused by this form of disease. It occurs due to the reactivation of dormant primary tuberculosis; as a progressive primary lesion; hematogenous spread to the lungs.

At times tuberculosis remains symptom­free and is diagnosed on routine radiography.

Clinical Features Postprimary Tuberculosis.

Symptoms Postprimary Tuberculosis.

1. Evening rise in temperature
2. Night sweats
3. Malaise and cachexia
4. Irritability and difficulty in concentration.
5. Cough and expectoration for more than three weeks.
6. Pleuritic chest pain
7. Breathlessness is a feature of advanced disease.
8. Indigestion and dyspnea
9. Amenorrhea often in young women
10. Hoarseness of voice.
11. Sputum can be mucoid, purulent, or blood-stained.
12. Hemoptysis is a classical feature
13. Presence of localized wheeze from local ulcer or narrowing of
14. major bronchus.
15. Presence of recurrent cold.

Physical signs Postprimary Tuberculosis.

1. Fever and weight loss
2. Tachycardia and tachypnea
3. Rapid pulse rate
4. Physical signs of collapse, consolidation, cavitation, fibrosis, bronchiectasis, pleural effusion, or pneumothorax.
   • In some cases only localized *rhonchi or rales are present.
5. Clubbing of fingers is present in chronic disease.
6. The most common physical sign of the chest is fine crepitation in the upper part of one or both lungs. This is heard on taking a deep breath after coughing.
7. Later on, there can be the presence of dullness to percussion or bronchial breathing in the upper part of one or both lungs.
8. In chronic cases, there is evidence of volume loss and mediastinal shift.
9. Hilar, mediastinal, and cervical group lymph nodes are enlarged with splenomegaly.

Management Postprimary Tuberculosis.

Treatment regimen under rntcP for Mdr-tB (Multidrug-resistant TB) and Xdr—tB (extensively drug-resistant TB)

1. For MDR-TB:

1. Six drugs in intensive phase for 6-9 months: Kanamycin,
2. Levofloxacin, Ethionamide, Cycloserine, Pyrazinamide, and Ethambutol.
3. Four drugs in the continuation phase for 18 months:
   • Levofloxacin, Ethionamide, Cycloserine and Ethambutol.
4. Reserve drug is p­aminosalicylic acid.

2. For XDR-TB

1. Seven drugs in intensive phase for 6-12 months:
   1. Capreomycin, p-aminosalicylic acid, Moxiflxacin,high­dose Isoniazid, Clofazimine, Linezolid,
   2. Amoxicillin and Clavulinic acid.
2. Six drugs in the continuation phase for 18 months: p­aminosalicylic acid, Moxifloxacin, high-dose isoniazid, Clofazimine, Linezolid, Amoxicillin, and Clavulinic acid.
3. Reserve drugs: Clarithromycin, Thiacetazone