Signs And Symptoms Of Tuberculosis (TB)

Tuberculosis or TB is a deadly disease causing the death of over one million people worldwide. It is scary but the good news is the number of cases of TB has seen a steady decline from the year 2000.¹ But TB continues to scare people because it is one of the top 10 causes of death worldwide. The WHO figures suggest that an estimated 49 million lives were saved through timely diagnosis and treatment between 2000 and 2015. If you know the symptoms of the disease, you can avoid the consequences to an extent.

Types Of Tuberculosis

Active, Latent And Miliary TB

Tuberculosis is caused by a bacteria called Mycobacterium tuberculosis that cause tissue damage. It mostly infects lungs which result in pulmonary tuberculosis; it can also affect any other organ resulting in extrapulmonary tuberculosis. The TB bacteria can enter your body and you may not even know about it. When it doesn’t manifest as symptoms or spread to others, it is called latent TB. Latent TB infection or LTBI may stay that way or go on to become tuberculosis.² If it starts showing symptoms like a cough, weakness of the body, weight loss, etc, you should understand that the disease has entered the active stage or has become active TB. It can spread to others now and treatment needs to be taken immediately. Then there is a form of active TB, though rare, where the bacteria enter the bloodstream affecting multiple organs. This type, called miliary TB, can be fatal.³

The infection may not always follow the same path. You could completely skip the latent stage and get active TB right away or the bacteria can stay latent or “asleep” in your body forever.

Symptoms Of Tuberculosis

If you are infected with TB, your body will send out certain warning signals. For adults and older children, it manifests in the form of:

• Anorexia
• Fatigue
• Weight loss
• Chills
• Night sweats
• Cough
• Hemoptysis
• Chest pain

In younger children, common symptoms include fever, lassitude, and cough. In the case of extrapulmonary TB, where the disease infects parts of the body other than lungs, there will be symptoms particular to that organ other than the classic or constitutional symptoms mentioned already. For example, if the bacteria attack the bone, you will have bone and joint infection. Expect renal infection if it is the kidneys that are affected.⁴

Symptoms Of Pulmonary TB

Pulmonary TB is when TB infects the lungs. There will be chills, fever and sweating at night. The body will go weak, you could experience a loss of appetite and severe weight loss.

Weight Loss

TB patients suffer from severe weight loss and loss of fat. This could lead to suppressed production of satiety hormone leptin which will increase the severity of the disease.⁵

Tissue Loss

The tuberculosis bacteria attack body tissues–both lean and fat tissues–resulting in wasting or severe tissue loss. The lean tissue depletion is found greater in limbs and fat tissue depletion is pronounced in the trunk.⁶

Other typical symptoms of pulmonary TB include a cough, pain in the chest and coughing up blood called hemoptysis.

Cough

A cough is a good indicator of pulmonary tuberculosis but all coughs are not that of TB. A cough that lasts for three weeks or longer should be taken seriously,⁷ in which case a TB test needs to be done. It is not just that timely diagnosis is good for effective treatment, it is through a cough that TB spreads. A cough produces small droplets that remain suspended in the air for a long duration, making it easy for the bacteria to spread.⁸

Hemoptysis

Hemoptysis can make the patient spit blood after coughing. If left unchecked, hemoptysis can suddenly progress into massive hemoptysis depending on the patient’s status and can be dangerous.⁹

Symptoms Of Extrapulmonary TB

Extrapulmonary TB or EPTB in any other part of the body other than lungs can occur in isolation or along with pulmonary TB. It can get worse in patients already suffering from autoimmune diseases like AIDS. In people who have immunity, EPTB accounts for only 15-20 percent; it, however, scales to about 50 percent in people with HIV infection. While any part of the body can get infected, it is often pleura and lymph nodes that are most commonly affected.¹⁰

Some of the organs that often get affected are:¹¹

• Pleura
• Lymph nodes
• Bones and joints
• CNS (usually meningitis, but can occur in brain or spine)
• Larynx
• Pericardial
• Abdominal
• Genitourinary tract
• Ocular
• Cutaneous

Apart from constitutional symptoms like fever, anorexia, weight loss, fatigue, etc, certain symptoms specific to the affected organ will also be shown. Here are some commonly occurring EPTB and the symptoms:

Pleural Tuberculosis: In the US, pleural tuberculosis accounts for about 5 percent of tuberculosis.¹² Most patients complain of pleuritic chest pain, nonproductive cough, and difficulty in breathing.¹³ Physical examination may reveal digital clubbing, effusion, and intercostal tenderness. Occasionally, pus may get collected in the chest wall or sinus tract.

Lymph Nodes Tuberculosis or Lymphadenitis: The most commonly seen extrapulmonary TB the world over, it often affects children and young adults though women are also easy targets of the bacteria. Otherwise asymptomatic, patients may gradually experience enlargement of lymph nodes.

Abdominal Tuberculosis: When TB infects the gastrointestinal tract, peritoneum, omentum, mesentery and its nodes and other solid intra-abdominal organs such as liver, spleen, and pancreas, it is termed abdominal tuberculosis. It has non-specific features and is hard to diagnose. In a study done on 36 patients, abdominal pain and pronounced weight loss were found to be the predominant complaints, followed by loss of appetite, nausea, vomiting or diarrhea.¹⁴

Spinal Tuberculosis: A destructive form of tuberculosis, spinal tuberculosis accounts for approximately half of all cases of musculoskeletal tuberculosis. Mostly seen in children and young adults, it is the thoracic region of the vertebral column that is most frequently affected. Formation of a ‘cold’ abscess around the lesion is another characteristic feature. Common symptoms include back pain, spinal tenderness, paraplegia, and spinal deformities.¹⁵

Cutaneous/Skin Tuberculosis: There are different kinds of skin tuberculosis–Scrofuloderma, Tuberculosis periorificialis, Acute miliary tuberculosis, Tuberculous gumma, Lupus vulgaris, Tuberculosis verrucosa cutis and Tuberculids. TB manifests as lesions on the skin and the type of lesion depends on the type of TB. Skin TB, however, remains to be one of the most elusive and difficult diagnoses to make because a wide variety of other skin conditions need to be considered before a proper diagnosis is made.¹⁶

Tuberculosis is a dangerous disease which makes timely diagnosis all the more important. Do not leave any of the symptoms to go unnoticed. Get a TB test done and get it treated before it is too late.