Clinical Presentation

Tuberculosis can be a life-threatening infection. For pulmonary TB, symptoms include cough, fever, dyspnea, night sweats, and weight loss or failure to gain weight. The few physical findings other than weight loss can include wheezes, rales, or signs of consolidation in the affected lung field. Hematogenous spread can lead to signs of extrapulmonary infection. Patients with an initial diagnosis of CAP might instead have TB. Patients with CAP who have symptoms suggesting TB or who do not respond to antibiotic treatment, who have upper lobe infiltrates or cavitary lesions, who come from endemic areas, or who have persistent cough or hemoptysis should be evaluated for TB (Kunimoto and Long, 2005).

For patients with symptoms or with a positive PPD, chest radiograph and sputum cultures for AFB are required. Typical chest x-ray findings include hilar or mediastinal lymph-adenopathy, patchy infiltrates, apical scarring, and pleural effusions, but a cavitary lesion or miliary pattern (typical millet-seed granulomas scattered diffusely throughout lung fields) more specifically suggests TB.

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