TB presents initially as flu-like symptoms. As the disease progresses, it manifests itself with chronic cough with blood-tinged sputum, fever and night sweats. Patients also complain of weight loss, malaise, retrosternal pain and weakness. There may also be cutaneous lesions. Primary infection usually persists for 7-14 days.

Extrapulmonary tuberculosis most frequently presents with lymphadenitis. It may also cause leukocytosis and anemia, however, the findings are nonspecific. Tuberculous meningitis presents with persistent headache, altered mental status which may progress to coma and low grade fever. Skeletal TB most commonly affects the spine, called Potts disease.

• Fever

  These people have a nonproductive cough, chest pain, and fever. The disease may go away and then come back at a later date. [web.archive.org]

  The patient was restarted on anti-TB therapy resulting in the resolution of her fever and skin lesions. [ncbi.nlm.nih.gov]

• Weight Loss

  Even then the symptoms -- loss of weight, loss of energy, poor appetite, fever, a productive cough, and night sweats -- might easily be blamed on another disease. [web.archive.org]

  The general symptoms of TB disease include Unexplained weight loss Loss of appetite Night sweats Fever Fatigue Chills The symptoms of TB of the lungs include Coughing for 3 weeks or longer Hemoptysis (coughing up blood) Chest pain Other symptoms depend [cdc.gov]

  A previously healthy 15-year-old rural adolescent male presented with a 2-month history of weight loss and fatigue. We strongly suspected a Klatskin tumor; therefore, exploratory laparotomy was performed. [ncbi.nlm.nih.gov]

• Weakness

  You are more likely to get TB if you have a weak immune system. [medlineplus.gov]

  But in other people, especially people who have weak immune systems, the bacteria become active and cause TB disease. People with LTBI can take medicine so that they will never develop TB disease. [health.mo.gov]

  Other people may get sick years later when their immune system becomes weak for another reason. [web.archive.org]

  Some people develop TB disease soon after infection, while others develop TB disease later when their immune system becomes weak. [cdc.gov]

• Fatigue

  A previously healthy 15-year-old rural adolescent male presented with a 2-month history of weight loss and fatigue. We strongly suspected a Klatskin tumor; therefore, exploratory laparotomy was performed. [ncbi.nlm.nih.gov]

  Although TB symptoms vary depending on which part of the body the disease infects, symptoms of TB of the lungs typically include: • A bad cough lasting more than two weeks • Coughing up blood or sputum (phlegm from deep in the lungs) • Chest pain, fever, fatigue [giantmicrobes.com]

  Symptoms of TB in the lungs may include A bad cough that lasts 3 weeks or longer Weight loss Loss of appetite Coughing up blood or mucus Weakness or fatigue Fever Night sweats Skin tests, blood tests, x-rays, and other tests can tell if you have TB. [medlineplus.gov]

  Fatigue and weight loss may follow. If the disease progresses and cavities form in the lungs, the person might have coughing and the production of saliva, mucus, or phlegm that may contain blood. [kidshealth.org]

• Chills

  […] vary depending on which part of the body the disease infects, symptoms of TB of the lungs typically include: • A bad cough lasting more than two weeks • Coughing up blood or sputum (phlegm from deep in the lungs) • Chest pain, fever, fatigue/weakness, chills [giantmicrobes.com]

  […] sputum Weakness Tiredness Swollen glands Weight loss Decrease in appetite Fever Sweating at night Chills The symptoms of TB can be like other health conditions. [urmc.rochester.edu]

  He had chills, was tired all the time, and had no appetite. After almost a month of night sweats, chest pain, persistent cough, and losing about 30 pounds, Shaka knew something was really wrong, and went to the doctor. [cdc.gov]

  Those with TB disease can show any of the following symptoms: Bad cough (lasting longer than 2 weeks) Pain in the chest Coughing up blood or sputum (mucus) Fatigue or weakness Loss of appetite Weight loss Chills Fever Night sweats Get useful, helpful [my.clevelandclinic.org]

• Cough

  Cough and difficulty breathing are less common. Generally, return of dormant tuberculosis infection occurs in the upper lungs. Symptoms include common cough with a progressive increase in production of mucus and coughing up blood. [web.archive.org]

  Coughing or sneezing by infected persons is the most common cause of transmission. [giantmicrobes.com]

  It can be transmitted by coughing, sneezing, spitting and even speaking by a person with an active infection. [symptoma.com]

  The general symptoms of TB disease include Unexplained weight loss Loss of appetite Night sweats Fever Fatigue Chills The symptoms of TB of the lungs include Coughing for 3 weeks or longer Hemoptysis (coughing up blood) Chest pain Other symptoms depend [cdc.gov]

• Pneumonia

  Clinicians failed to identify unilateral hilar abnormalities on CXR, and these patients were treated initially for pharyngitis, bronchitis, or pneumonia with no improvement. [ncbi.nlm.nih.gov]

  Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome. HIV Med 2008 ; 9 : 609 –615. ↵ Rabe KF, Hurd S, Anzueto A, et al. [doi.org]

  Young male patient with fever and cough has a focal opacity in the left lower lobe that looks like a pneumonia. This is a case of primary tuberculosis in an adult. [emedicine.com]

  Lung cancer, including both non-small cell lung carcinoma and small cell lung carcinoma.[4][5] Sarcoidosis[6] Aspergilloma[7] Tuberculosis[8] Histoplasmosis[9] Pneumonia Pulmonary edema Foreign body aspiration and aspiration pneumonia Goodpasture's syndrome [en.wikipedia.org]

  With many safer drugs available, telavancin has twice before been denied approval by the FDA for treating pneumonia. These same adverse reactions remained concerns regarding the pneumonia trials submitted to the November advisory committee. [healthaffairs.org]

• Hemoptysis

  /complications Hemoptysis/diagnostic imaging Hemoptysis/etiology* Homeless Persons Humans Imaging, Three-Dimensional Male Pulmonary Artery/diagnostic imaging Pulmonary Artery/microbiology Pulmonary Artery/pathology Tomography, X-Ray Computed Treatment [ncbi.nlm.nih.gov]

  Retrieved 3 March 2018. ^ a b Hemoptysis Causes – Hemoptysis – HealthCommunities.com ^ a b c d Other Causes of Hemoptysis – Hemoptysis – HealthCommunities.com ^ Uppsala Academic Hospital > Guidelines for treatment of acute lung diseases. [en.wikipedia.org]

• Pleural Effusion

  Pleural involvement in postprimary pulmonary tuberculosis Pleural involvement is seen more commonly in postprimary tuberculosis than in primary infection. Pleural effusions may occur and may progress to empyema. [emedicine.com]

  We report a 9-year-old girl from Mumbai, India with fever, bilateral pleural effusion, thrombocytopaenia, haemoconcentration and oliguria due to hantavirus infection. She also had associated tuberculosis. [ncbi.nlm.nih.gov]

• Chronic Cough

  cough, chest pain, hemoptysis or respiratory insufficiency. [orpha.net]

  […] during the chronic cough, individuals can further identify the cause of the chronic cough. [en.wikipedia.org]

  TB affecting the lungs presents with chronic cough with sputum, chest pain, fever, night sweats and weight loss. Skeletal TB presents with body aches, musculoskeletal pain and joint pain. [symptoma.com]

  When to You Call the Doctor Call the doctor if your child: has been in contact with a person who has (or is suspected to have) tuberculosis has persistent fever complains of sweating at night develops a persistent, chronic cough Date reviewed: January [kidshealth.org]

  It is spread through the air when people who have an active TB infection cough or sneeze. Symptoms of TB include a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. [pih.org]

• Loss of Appetite

  Even then the symptoms -- loss of weight, loss of energy, poor appetite, fever, a productive cough, and night sweats -- might easily be blamed on another disease. [web.archive.org]

  CASE PRESENTATION: We report a case of a 56-year-old Sri Lankan Sinhalese man who presented with pyrexia of known origin with significant loss of weight and loss of appetite. He had mild pallor with mild hepatosplenomegaly. [ncbi.nlm.nih.gov]

  loss of appetite, and night sweats Both active and latent TB can be detected by injecting tuberculin under the skin and examining resultant bumps. [giantmicrobes.com]

  Symptoms of TB in the lungs may include A bad cough that lasts 3 weeks or longer Weight loss Loss of appetite Coughing up blood or mucus Weakness or fatigue Fever Night sweats Skin tests, blood tests, x-rays, and other tests can tell if you have TB. [medlineplus.gov]

  The main side effects are stomach upsets and discomfort, nausea and loss of appetite. Vomiting and diarrhoea may occur although this is rare. [healthywa.wa.gov.au]

• Abdominal Pain

  A 58-year-old Asian woman was referred to our hospital for evaluation of low back pain for 4 years and abdominal pain for 1 month. [ncbi.nlm.nih.gov]

• Nausea

  The main side effects are stomach upsets and discomfort, nausea and loss of appetite. Vomiting and diarrhoea may occur although this is rare. [healthywa.wa.gov.au]

  Abstract A 46-year-old woman who had a recent total abdominal hysterectomy presented with a 1 month history of lower abdominal pain, 1 week of nausea and vomiting as well as decreased urinary output preceded by a year of significant unintentional weight [ncbi.nlm.nih.gov]

  At the commencement he was troubled with nausea and cardialgia; thirsty, tongue was parched; urine thin and dark. [ebooks.adelaide.edu.au]

  TB of the brain can cause headaches and nausea. You won’t have any symptoms of tuberculosis unless you have active TB. What causes tuberculosis? TB is caused by bacteria. The bacteria spread through the air from one person to another. [familydoctor.org]

  Presentation Five days lower abdominal pain with anorexia, nausea, constipation. Patient Data Age: 37 Gender: Female A normal appearing anteverted, anti-flexed uterus is present. Endometrial stripe measures 4mm. Both ovaries are identified. [radiopaedia.org]

• Vomiting

  If you develop nausea (feeling sick), vomiting, stomach pain, yellow skin or eyes, or darker coloured urine you should contact your doctor or case manager immediately. [healthywa.wa.gov.au]

  Abstract A 46-year-old woman who had a recent total abdominal hysterectomy presented with a 1 month history of lower abdominal pain, 1 week of nausea and vomiting as well as decreased urinary output preceded by a year of significant unintentional weight [ncbi.nlm.nih.gov]

  On the sixteenth, vomited pretty frequently yellow, bilious matters. [ebooks.adelaide.edu.au]

  Common side effects include: upset stomach, nausea and vomiting or loss of appetite. tingling or numbness in the hands or feet itchy skin, rashes or bruising changes in your eyesight or blurred visions yellowish skin or eyes dark-colored urine weakness [lung.org]

• Failure to Thrive

  General symptoms : fatigue, malaise, fever, weight loss, anorexia, failure to thrive and pyrexia of unknown origin (PUO). Pulmonary : respiratory TB accounts for 60% of cases in the UK. [patient.info]

  […] to gain weightmqone (failure to thrive) TanInfected inficirebis sawinaaRmdego mkurnalobam (igulisxmeba LTBI -is sawipersons without disease who are at high risk of developing naaRmdego profilaqtikuri mkurnaloba, igive izoniazidiT prevenTB may benefit [kipdf.com]

• Liver Tenderness

  […] such as fatigue, anorexia, nausea, jaundice, dark urine, liver tenderness, or hepatomegaly) should prompt additional evaluation by the prescriber. — Discontinuation of bedaquiline should be considered if the following laboratory abnormalities are present [cdc.gov]

• Back Pain

  A 58-year-old Asian woman was referred to our hospital for evaluation of low back pain for 4 years and abdominal pain for 1 month. [ncbi.nlm.nih.gov]

  For example, kidney infection causes back pain and blood in your urine. Brain infection causes headache, confusion, and drowsiness. Spine infection causes back pain. [msdmanuals.com]

  For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine. [mayoclinic.com]

• Arthralgia

  We describe a 67-year-old Sri Lankan woman who manifested relapsing prolonged fever, raised inflammatory markers, arthralgia, myalgia, transient skin rash, and cervical lymphadenopathy histologically characterized by noncaseating granulomatous adenitis [ncbi.nlm.nih.gov]

  The most common side effects with Sirturo (which may affect more than 1 in 10 people) are headache, dizziness, nausea (feeling sick), vomiting, and arthralgia (joint pain). [ema.europa.eu]

  Monitoring Persons receiving bedaquiline should be monitored weekly for nausea, headache, hemoptysis, chest pain, arthralgia and rash, and treatment should be modified as clinically indicated. [cdc.gov]

• Shoulder Pain

  These patients appear septic as well, and often present with right upper quadrant or referred right shoulder pain. Elevated liver function studies confirm the diagnosis. [saem.org]

• Sweating

  Even then the symptoms -- loss of weight, loss of energy, poor appetite, fever, a productive cough, and night sweats -- might easily be blamed on another disease. [web.archive.org]

  On the seventh, had a sweat; the fever intermitted, the pains remained. [ebooks.adelaide.edu.au]

  […] is a contagious-infectious disease caused mainly by Mycobacterium tuberculosis that in most individuals is usually asymptomatic but that in at risk individuals (e.g. with diabetes or with HIV infection) can cause weakness, fever, weight loss, night sweat [orpha.net]

  The patient reported no pain at other sites, exhibited no fever or night sweats, and was unable to recall any recent injury. [ncbi.nlm.nih.gov]

  After almost a month of night sweats, chest pain, persistent cough, and losing about 30 pounds, Shaka knew something was really wrong, and went to the doctor. [cdc.gov]

• Night Sweats

  Even then the symptoms -- loss of weight, loss of energy, poor appetite, fever, a productive cough, and night sweats -- might easily be blamed on another disease. [web.archive.org]

  sweat, and respiratory anomalies such as chronic cough, chest pain, hemoptysis or respiratory insufficiency. [orpha.net]

  The patient reported no pain at other sites, exhibited no fever or night sweats, and was unable to recall any recent injury. [ncbi.nlm.nih.gov]

  sweats Both active and latent TB can be detected by injecting tuberculin under the skin and examining resultant bumps. [giantmicrobes.com]

  Symptoms of TB in the lungs may include A bad cough that lasts 3 weeks or longer Weight loss Loss of appetite Coughing up blood or mucus Weakness or fatigue Fever Night sweats Skin tests, blood tests, x-rays, and other tests can tell if you have TB. [medlineplus.gov]

• Kidney Failure

  The most common risk factor is: Other risk factors include: Diabetes Severe kidney failure Certain cancers Drugs such as corticosteroids and new inflammation-blocking drugs Sometimes TB becomes active even if you don't have risk factors. [msdmanuals.com]

  Analysis of the company’s own studies showed that the sickest patients-- those with diabetes, heart failure, and kidney failure-- were most likely to die if they took telavancin compared to vancomycin. [healthaffairs.org]

  Analysis of the company’s own studies showed that the sickest patients– those with diabetes, heart failure, and kidney failure– were most likely to die if they took telavancin compared to vancomycin. [web.archive.org]

  Other countries rely on even older regimens that include daily injections of antibiotics that can have devastating side effects, including deafness, kidney failure and psychosis. But in the trial Ms. [nytimes.com]

• Flank Pain

  […] arthritis: usually pain in a single joint (hips and knees most common) Genitourinary TB: dysuria, flank pain, increased frequency, masses or lumps (granulomas) Gastrointestinal TB: difficulty swallowing, nonhealing ulcers, abdominal pain, malabsorption [medicinenet.com]

  Other symptoms include back pain, flank pain, PID symptoms, confusion, coma, difficulty swallowing, and many other symptoms that would be a part of other diseases.[10] (Please see the reference for more information on symptoms.) [en.wikipedia.org]

  pain Dysuria Frequent urination In men, a painful scrotal mass, prostatitis, orchitis, or epididymitis Symptoms of gastrointestinal TB are referable to the infected site and may include the following: Nonhealing ulcers of the mouth or anus Difficulty [emedicine.com]

• Strangury

  But, with regard to the strangury itself, the symptoms were protracted and painful. Their urine was copious, thick, of various characters, red, mixed with pus, and was passed with pain. [ebooks.adelaide.edu.au]

• Headache

  Tuberculous meningitis presents with persistent headache, altered mental status which may progress to coma and low grade fever. Skeletal TB most commonly affects the spine, called Potts disease. [symptoma.com]

  The most common side effects with Sirturo (which may affect more than 1 in 10 people) are headache, dizziness, nausea (feeling sick), vomiting, and arthralgia (joint pain). [ema.europa.eu]

  Brain infection causes headache, confusion, and drowsiness. Spine infection causes back pain. [msdmanuals.com]

• Altered Mental Status

  Tuberculous meningitis presents with persistent headache, altered mental status which may progress to coma and low grade fever. Skeletal TB most commonly affects the spine, called Potts disease. [symptoma.com]

Laboratory tests

Screening:

• Tuberculin skin test (using PPD)
• Interferon-Gamma release Assay (IGRA): IGRA assays offer certain advantages over tuberculin skin testing [6].

Suspected TB:

• Acid-fast staining of sputum or other specimens
• Culture in Lowenstein-Jensen agar
• Nucleic acid amplification tests
• Luciferase Assay which can detect drug resistant organisms [2]
• HIV serology

Imaging

Imaging studies include chest radiography and CT scan which can show pulmonary infiltrates. A biopsy can be performed, but is rarely needed.

Test results

On the basis of clinical evaluation and laboratory test results, TB can be definitively diagnosed. Susceptible individuals should also be screened for latent TB. The goal of testing for latent tuberculosis infection (LTBI) is to identify individuals who are at increased risk for the development of tuberculosis (TB) and therefore would benefit from treatment of LTBI [7].

• Atelectasis

  Atelectasis may resolve as lymphadenopathy regresses with host response. A sudden resolution of atelectasis may represent perforation of an infected lymph node into the airway, which relieves the bronchial obstruction. [emedicine.com]

  Chest X-ray and CT scan of the chest showed partial atelectasis and a segmental collapse of the right upper lobe and tumor-like arising from its bronchus along with a large right para-tracheal mediastinal lymphadenopathy, mimicking a metastatic (N2) disease [ncbi.nlm.nih.gov]

  Palpation of the lymph nodes could also be informational during an examination [11] Differential Diagnosis Chronic Bronchitis Bronchiectasis Atelectasis Pneumonia Influenza Arthritis (Extrapulmonary) [4] Case Studies Jha A, Shojania K, Saint S. [physio-pedia.com]

  Adenopathy may progress, even after chemotherapy is started, and may cause lobar atelectasis, which usually clears during treatment. Cavitary disease is less common than in adults, and most children harbor far fewer organisms and are not contagious. [merckmanuals.com]

• Pyuria

  We present a case of a 47-year-old African-American woman with relapsing urinary infection and sterile pyuria. After a 4 four-year evolution, the patient developed functional exclusion of the right kidney as a consequence of chronic pyelonephritis. [dx.doi.org]

  Urinary Tract Tuberculosis: A "sterile pyuria" with WBC's present in urine but a negative routine bacterial culture may suggest the diagnosis of renal tuberculosis. Progressive destruction of renal parenchyma occurs if not treated. [library.med.utah.edu]

  After two weeks of antibiotic treatment, leukocytosis, pyuria, and sepsis resolved, but intermittent fever lasted along with pelvic tenderness. [bmcwomenshealth.biomedcentral.com]

  Genitourinary : the most common site outside the lungs often presents with 'sterile' pyuria. There may be kidney lesions, salpingitis, abscesses and infertility in females and swelling of the epididymis in males. [patient.info]

• Pleural Effusion

  Pleural involvement in postprimary pulmonary tuberculosis Pleural involvement is seen more commonly in postprimary tuberculosis than in primary infection. Pleural effusions may occur and may progress to empyema. [emedicine.com]

  We report a 9-year-old girl from Mumbai, India with fever, bilateral pleural effusion, thrombocytopaenia, haemoconcentration and oliguria due to hantavirus infection. She also had associated tuberculosis. [ncbi.nlm.nih.gov]

• Leukocytosis

  After two weeks of antibiotic treatment, leukocytosis, pyuria, and sepsis resolved, but intermittent fever lasted along with pelvic tenderness. [bmcwomenshealth.biomedcentral.com]

  History and Physical The classic presentation of a TOA includes abdominal pain, pelvic mass on examination, fever, and leukocytosis. [ncbi.nlm.nih.gov]

Medication

Anti-tuberculous chemotherapy is the mainstay of treatment and highly effective. The most commonly used antibiotics used are isoniazid (INH) and rifampicin. The recommended treatment of new-onset pulmonary tuberculosis, as of 2010, is 6 months of a combination of antibiotics containing rifampicin, isoniazid, pyrazinamide, and ethambutol for the first two months [8]. Only rifampicin and isoniazid need to be continued for the last four months.

Directly observed therapy

Patient compliance is generally found to be non satisfactory. To overcome this hurdle, directly observed therapy (DOT) has become an important part of treatment. Individual case management with DOT is very important for facilitating adherence and preventing the development of drug resistance and represents the standard of care in the United States today [9].

TB infection does not always progress to active TB disease, but since both active and latent TB responds well to antituberculous chemotherapy, it has an excellent prognosis. Identification and treatment of latent tuberculosis infection can reduce the risk of development of disease by as much as 90 percent [5].

Mycobacterium tuberculosis

The primary causative agent of tuberculosis is the slender, rod-shaped obligate aerobe called Mycobacterium tuberculosis (other mycobacteria can also cause this disease). It is acid-fast due to the high lipid content (up to 60%) of their cell walls. 3 important constituents include [2]:

• Long-chain fatty acids (C78-C90) called Mycolic acids which contribute to the acid-fastness.
• Wax D serves to enhance the immune response. 
• Phosphatides play a role in caseous necrosis.

Transmission

TB is an air-borne infection. It can be transmitted by coughing, sneezing, spitting and even speaking by a person with an active infection. All such actions result in expulsion of infectious aerosol particles or droplets that contain the bacteria which may be inhaled by anyone present in the vicinity. Since the infectious dose of TB is very low, inhalation of as little as 10 organisms can lead to the development of this disease. People in close contact with such a person are particularly at high risk.

Genetics

Many patients are genetically vulnerable to this disease. Polymorphisms in some genes, for example in NRAMP1 gene which encodes the NRAMP1 transmembrane protein that pumps divalent ions out of lysosomes, may result in ineffectual immune response of the host. NRAMP1 may inhibit microbacterial growth by limiting availability of ions needed by the bacteria [3]. So a genetic defect in this gene may make the host vulnerable to TB.

Incidence

TB is estimated to affect 1.7 billion individuals worldwide with approximately 1.6 million deaths annually. 

Age

Tuberculosis is typically a disease of older people. Immuno-compromised individuals, however, are at risk, irrespective of age.

Sex

The disease is found more in males than in females.

Race

TB is prone to develop in poverty stricken areas and so, in many regions of various third world countries this disease is a common occurrence. It has the highest occurrence in Asians, followed by Hispanics and then African-Americans. 

Mycobacterium tuberculosis enters macrophages by endocytosis mediated by several factors. Once inside, it begins to replicate in the pulmonary airspaces and alveolar macrophages. Despite bacteremia, most patients at this stage are asymptomatic. About 3 weeks after infection, a T-H1 response is mounted that activates macrophages to become bactericidal [4]. The activated T-H1 cells produce Interferon gamma which is critical in containing the infection. NK-1 cells also produce IFN-y. IFN-y enables macrophages to differentiate into epitheloid histiocytes which are characteristic findings of granulomas. Caseous necrosis ensues in an attempt to close off and destroy the bacteria.

The primary formed lesions are 1-1.5 cm areas of inflammation with consolidation called Ghon focus. They begin to caseate and some of the bacteria disseminate into regional lymph nodes. This caseated lesion along with lymph node involvement constitutes the Ghon complex. In subsequent weeks the tubercle bacteria disseminate to the rest of the body via both lymphatic and hematogeneous spread. The Ghon complex undergoes progressive fibrosis turning into calcified lesions called Ranke complex.

All this results in three major effects: Reduced breathing and vital capacity, reduced total respiratory membrane surface area and increased thickness of the respiratory membrane, and lastly, abnormal ventilation-perfusion ratio of the lung.

TB can be prevented with the use of BCG vaccine. This vaccine contains a strain of live, attenuated Mycobacterium bovis called bacillus Calmette-Guerin. It can also be prevented by living in well-aired, less crowded quarters and using boiled water and pasteurized milk. The PPD screening test should also be regularly performed in people belonging to susceptible demographics.

Tuberculosis (TB) is a multisystemic disease commonly affecting the lungs. It is due to an infection by bacteria of the Mycobacteria genus. It is transmitted when people who have an active TB infection cough, sneeze, or otherwise transmit respiratory fluids through the air [1]. It is one of the most common infectious diseases in the world and a source of high infection-associated mortality, second only to HIV. The World Health Organization is still attempting to eradicate the disease from the world and has been quite successful in significantly decreasing the incidence of TB in many developed countries.

Definition

Tuberculosis (TB) is an infectious disease that occurs due to transmission of bacteria from a person with an active TB infection to a healthy individual. Patients that are immune-compromised, for e.g HIV patients, are at higher risk of contracting this disease. 

Cause

TB is most commonly due to an infection by Mycobacterium tuberculosis. Other strains like Mycobacterium bovis may also cause TB. Transmission is through air, like during coughing or sneezing via aerosol droplets containing the infectious particles. 

Signs and symptoms

Signs and symptoms vary according to the type of TB. TB affecting the lungs presents with chronic cough with sputum, chest pain, fever, night sweats and weight loss. Skeletal TB presents with body aches, musculoskeletal pain and joint pain. Tuberculous meningitis presents with headache, altered mental status, fever and sometimes coma.

Diagnosis

Diagnostic evaluation for TB may be initiated in outpatient settings [10]. Patients that are susceptible to this disease should be screened. Diagnosis is made based on history, chest radiography and positive blood/sputum cultures. 

Treatment

Treatment is ideally a quadruple therapy of antibiotics that should be continued for 6 months to prevent recurrence.

1. Konstantinos A. Testing for tuberculosis. Australian Prescriber 33 (1): 12–18, 2010.
2. Warren Levinson: Review of Medical Microbiology and Immunology. 11th ed. Pa: McGraw Hill, 2010. ISBN 978-0-07-170028-3
3. Cellier MF, et al. NRAMP1 phagocyte intracellular metal withdrawal defense. Microbes Infect 9:1662, 2007.
4. Flynn JL, Chan J. Immunology of tuberculosis. Annu Rev Immunol 19:93, 2001.
5. Comstock GW. How much isoniazid is needed for prevention of tuberculosis among immunocompetent adults? Int J Tuberc Lung Dis 1999; 3:847.
6. Mazurek GH, Jereb J, Lobue P, Iademarco MF, Metchock B, Vernon A. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep. Dec 16 2005;54:49-55
7. Mancuso JD, Tribble D, Mazurek GH, et al. Impact of targeted testing for latent tuberculosis infection using commercially available diagnostics. Clin Infect Dis 2011; 53:234.
8. Lawn SD, Zumla AI. Tuberculosis. Lancet 378 (9785): 57–72. 2 July 2011 doi:10.1016/S0140-6736(10)62173-3. PMID 21420161
9. Blumberg HM, Burman WJ, Chaisson RE, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003; 167:603.
10. Taylor Z, Marks SM, Ríos Burrows NM, et al. Causes and costs of hospitalization of tuberculosis patients in the United States. Int J Tuberc Lung Dis 2000; 4:931.