Systemic symptoms, likely related to cytokine release, often appear early in the course of disease and with reactivation. Fever is common in TB and is often relapsing and remitting. This is considered one of the constitutional symptoms of this disease.
Night sweats are another systemic finding in tuberculosis and are considered one of the constitutional symptoms seen in this disease. Most patients will complain that they see this several times a week.
Weight loss is common in tuberculosis and likely related to systemic cytokine release.
Hemoptysis, or the coughing up of blood, is present in approximately one-half of pulmonary tuberculosis cases. Patients presenting with hemoptysis and risk factors for TB should be thoroughly screened, given the strong correlation between this symptom and disease.
Mycobacteria typically enter the body through the lungs, but can then disseminate widely through the bloodstream and lymphatic system. This can lead to widespread infections in any organ, including the adrenal glands, CNS, GI, liver, vertebrae, kidneys, and bone. Dissemination can also lead to sepsis and death.
Addison's disease, or primary adrenal insufficiency, is a disorder in which the adrenal glands cannot produce sufficient steroid hormones, including cortisol and aldosterone. It can be caused by dissemination of tuberculosis to the adrenals glands, and this is an important cause of Addison's disease worldwide.
Tuberculosis can seed in the CNS via hematogenous transmission, especially into the meninges. TB meningitis presents with fever, headache, meningismus, and cranial nerve dysfunction. CSF examination will show high numbers of lymphocytes.
Liver involvement can present with abdominal pain in the right upper quadrant, vomiting, and diarrhea. Jaundice secondary to cholestasis is also seen. Historically on autopsy, the finding of diffuse liver granulomas looked like millet seeds, leading to the term miliary TB.
TB involvement of the kidneys can present non-specifically with pyuria and hematuria. There may be a history of negative urine cultures if TB was not previously suspected.
TB can invade any portion of the GI tract, most commonly the peritoneum and intestines. This can present with abdominal pain, distension, ascites, and diarrhea.
Tuberculosis also commonly travels to the bone via hematogenous spread. This can cause a variety of diseases depending on the location, including arthritis, osteomyelitis, and spondylitis.
Pott’s disease, or tuberculous spondylitis, is the infection of the vertebrae by Mycobacteria. It often occurs in the lower vertebral segments and can result in systemic signs of infection, pain, and eventually vertebral collapse.
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