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Chapter 2 : Overview of Clinical Tuberculosis

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Abstract:

The clinical expression of infection with is quite varied and depends on a number of identified factors. The most obvious and important factor influencing the clinical features of tuberculosis is the site of involvement. Tuberculosis occurring at any site may cause symptoms and findings that are not related specifically to the organ or tissue involved but, rather, are systemic in nature or are remote from the site of disease. Weight loss, weakness, and malaise appear to be less common but are more difficult to quantify. Tuberculosis that occurs relatively early in the course of HIV infection tends to have the typical radiographic findings described. Because of the frequency of extrapulmonary tuberculosis among HIV-infected patients, diagnostic specimens from any suspected site of disease should be examined for mycobacteria. Prior to the HIV epidemic, lymph node tuberculosis made up approximately 20% of the cases of extrapulmonary tuberculosis in the United States. The diagnosis of pleural tuberculosis is generally established by analysis of pleural fluid and/or by pleural biopsy. The incidence of tuberculosis involving the joints and bones increases with increasing age and is equally frequent in men and women, making up approximately 9% of cases of extrapulmonary tuberculosis overall. Meningitis is the most frequent form of central nervous system tuberculosis; solitary or multiple tuberculomas occur less commonly. The chest pain occasionally mimics angina but usually is described as being dull, aching, and often affected by position and by inspiration.

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2

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Figures

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Figure 1

Distribution of sites of involvement in newly reported cases of tuberculosis in 1978 prior to the epidemic of infection with HIV

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2
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Figure 2

Frontal view chest radiograph showing extensive tuberculosis causing respiratory failure.

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2
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Figure 3

Frontal view chest radiograph showing right paratracheal adenopathy as a manifestation of recently acquired tuberculous infection.

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2
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Figure 4

Frontal view chest radiograph showing the typical findings of endogenous reactivation tuberculosis in an immunocompetent patient. Note the upper lobe location and cavitation.

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2
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Figure 5

Portion of chest radiograph showing nodular lesions in a patient with disseminated tuberculosis.

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2
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Image of Figure 6
Figure 6

Frontal view chest radiograph showing diffuse infiltration caused by in a patient with HIV infection.

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2
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Figure 7

Age-specific case rates for the most frequent forms of extrapulmonary tuberculosis.

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2
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Figure 8

Computed tomographic scan of the chest showing a tuberculosis empyema with adjacent chest wall involvement (A) and a large chest wall abscess overlying the sternum with mediastinal involvement (B).

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2
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Tables

Generic image for table
Table 1

Factors influencing the clinical features of tuberculosis

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2
Generic image for table
Table 2

Recovery of from various sites in patients with tuberculosis and HIV infection

Citation: Hopewell P, Jasmer R. 2005. Overview of Clinical Tuberculosis, p 15-31. In Cole S, Eisenach K, McMurray D, Jacobs, Jr. W (ed), Tuberculosis and the Tubercle Bacillus. ASM Press, Washington, DC. doi: 10.1128/9781555817657.ch2

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