- Typically via inhalation of mycobacterium TB droplets
- 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
- 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 normal CXRs (ie no pulmonary manifestations of TB)
- 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)