Tuberculosis (TB)

Etiology

  • Typically via inhalation of mycobacterium TB droplets

Risk Factors

  • Malnutrition
  • Immunocompromised for any reason (e.g. HIV+ and low CD4, malnourished, other), though can occur in anyone
  • Chronic steroids, TNF inhibitors, other meds that affect T-cell function
  • Known HIV or HIV RFs
  • Extra-pulmonary TB increases in HIV+ w/CD4 < 350
  • Born or visit to an endemic area (e.g. Mexico, Central America, many other)
  • PPD or IGRA + (Latent TB), w/o receiving treatment

Symptoms

  • Cough x weeks, hemoptysis, SOB w/pneumonia
  • Weight loss, fever. sweats
  • Back pain w/vertebral involvement
  • Urinary frequency, dysuria, urgency w/GU involvement
  • Can affect any organ (or multiple) and cause focal symptoms (e.g. stomach, peritoneum, liver, CNS, etc.)
  • Progressive adenopathy (can be painless and may not be associated w/systemic sx)
  • Miliary TB is spread hematogenously, and can cause generalized and/or other organ system symptoms (f, c, sweat, wt loss, cough, etc)
  • In US, 20% of TB presents extra-pulmonary; Of those w/extra-pulmonary TB, 50% have nl CXRs

Physical Exam Findings

  • Can be chronically ill appearing
  • Lung findings of crackles, diminished breath sounds
  • Progressive adenopathy (called scrofula if in head and neck region), which can be painless and may not be associated w/systemic sx)
  • Bone pain or sinus track if boney involvement (called Pott's disease if affects spine)
  • Abnormalities in/over any other affected area
  • Other findings related to HIV (if that's the underlying driver)

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