0071643192.pdf

■ Host becomes immunocompromised (eg, HIV, malignancy, immunosup-

pressant medications) →reactivationof latent disease and symptoms.

■ Hematogenous spread during primary or reactivation →miliary TB.

SYMPTOMS/EXAM

■ Primary TB

■ Usually asymptomatic, but a small number of cases may develop pro-

gressive primary infection, resembling CAP

■ Latent TB

■ No symptoms of active disease, PPD+

■ Active TB/reactivation disease

■ Pulmonary TB: Persistent cough, malaise, night sweats, fever, weight

loss, and hemoptysis

■ Extrapulmonary TB: Sites include lymph node (most common), pleura,

genitourinary tract, bones and joints, pericardium, and meninges. See

Table 10.13 for clinical clues.

THORACIC AND RESPIRATORY

DISORDERS

TABLE 10.12. TB Risk Factors

Immunocompromise

Older age

Substance abuse

Malnutrition

Silicosis

Close contact with infected person

Crowded living conditions

Travel to endemic areas

Health- or residential-care work

Recent immigration

TABLE 10.13. Clinical Clues with Extrapulmonary TB

EXTRAPULMONARYLOCATION CLINICALCLUE

Meninges Lumbar puncture:

High opening pressure and protein

Lymphocyte predominance

↓Glucose

Pleura Exudative pleural effusion with

predominance of lymphocytes

Genitourinary tract Urinary tract complaints

WBCs without bacteria on UA

Miliary Abnormal CBC

Hepatosplenomegaly

Lymphadenopathy

Hyponatremia

CXR with millet seed-like densities