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Chapter 3 : 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. Immunization with bacillus of Calmette and Guérin (BCG) in persons with intact cell-mediated immunity minimizes the risk of early disseminated tuberculosis, especially in children. Systemic manifestations of the disease, including fever, malaise, and weight loss, are likely mediated by cytokines, especially tumor necrosis factor alpha (TNF-α). Weight loss, weakness, and malaise appear to be less common but are more difficult to quantify. Cough is the most common symptom of pulmonary tuberculosis. Tuberculosis that occurs relatively early in the course of HIV infection tends to have the typical radiographic findings described. Due to the frequency of extrapulmonary tuberculosis among HIV-infected patients, diagnostic specimens from any suspected site of disease should be examined for mycobacteria. Paravertebral or other para-articular abscesses may develop, with occasional formation of sinus tracts. Although weight-bearing joints are the most common sites for skeletal tuberculosis, any bone or joint may be involved. Meningitis is the most frequent form of central nervous system tuberculosis; solitary or multiple tuberculomas occur less commonly. The epidemiologic pattern of central nervous system tuberculosis is quite different from either pulmonary or other forms of extrapulmonary tuberculosis in that the peak incidence is in children in the zero-4-year age group, but an appreciable number of cases occur in adults. The chest pain may occasionally mimic angina but usually is described as being dull, aching, and often affected by position and by inspiration.

Citation: Hopewell P. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
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Figures

Image of Figure 1.
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. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
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Image of Figure 2
Figure 2

Frontal view, chest radiograph, showing extensive tuberculosis causing respiratory failure.

Citation: Hopewell P. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
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Image of Figure 3.
Figure 3.

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

Citation: Hopewell P. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
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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. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
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Image of Figure 5.
Figure 5.

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

Citation: Hopewell P. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
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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. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
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Image of Figure 7.
Figure 7.

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

Citation: Hopewell P. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
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Image of Figure 8.
Figure 8.

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

Citation: Hopewell P. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
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Tables

Generic image for table
Table 1.

Factors influencing the clinical features of tuberculosis

Citation: Hopewell P. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3
Generic image for table
Table 2.

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

Citation: Hopewell P. 1994. Overview of Clinical Tuberculosis, p 25-46. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch3

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