Clinical presentation

Fever, night sweats, weight loss, fatigue, and a productive cough are the classic symptoms of tb.1,2,6,19 Onset may be gradual, and the diagnosis is easily missed if the symptoms are muted, such as in the elderly.2,6,19 Progressive pulmonary disease leads to cavitation visible on x-ray. Physical examination is nonspecific but may be consistent with pneumonia. Dullness to chest percussion, rales, and increased vocal fremitus may be observed on examination. Laboratory data often are uninformative, but a modest increase in the white blood cell (WBC) count with a lymphocyte predominance can be seen.

Atypical presentations are common in patients coinfected with HIV. , HIVpositive patients often have negative skin tests and fail to produce cavitary lesions, and fever may be absent. Symptoms for these patients range from classic pulmonary to muted and nonspecific. Extrapulmonary TB typically presents as a slowly progressive decline in organ function, and lymphadenopathy is relatively common. 6 8,19 Abnormal behavior, headaches, or convulsions suggest tuberculous meningitis, although other acute CNS infections must be exlcuded.6,19

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