Tuberculosis: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate tuberculosis:

Main symptoms

  • Weight loss/weight loss*
  • General feeling of illness, signs of a flu-like infection
  • Concentration disorders
  • Fever* [subfebrile temperatures]
  • Increased sweating, especially at night (night sweats; nocturnal sweating).
  • Anorexia* (loss of appetite).
  • Fatigue
  • Weakness
  • Cough, first unproductive, later productive, ie with sputum; possibly with blood admixtures (hemoptysis / hemoptysis).
  • Thoracic pain (chest wall pain/chest pain; thoracic pain) or abdominal pain (abdominal pain* ; abdominal pain).
  • Lymphadenopathy (lymph node enlargement).
  • Dyspnea (shortness of breath)
  • Anemia (anemia)
  • Splenomegaly (enlargement of the spleen; with prolonged fever).

* Also think of abdominal tuberculosis; furthermore, ascites (abdominal fluid) and a plumped mesentery (duplication of the peritoneum originating from the posterior abdominal wall) due to lymph node enlargement may be present. Note: Up to 30% of those with pulmonary tuberculosis also have intestinal (belonging to the intestinal tract) manifestations.

Secondary symptoms

  • Pallor
  • Erythema nodosum (synonyms: nodular erythema, dermatitis contusiformis, erythema contusiforme; plural: erythemata nodosa) – granulomatous inflammation of the subcutis, also called panniculitis, and a painful nodule (red to blue-red color; later brownish). The overlying skin is reddened. Localization: both lower leg extensor sides, on the knee and ankle joints; less frequently on the arms or buttocks.
  • Nail symptoms:
    • Yellow fingernail syndrome (yellow-nails; yellow-nail syndrome) – yellowish discolored nails.
    • Drumstick finger (distension of the finger end links).

Frequent occurrence of B symptomatology:

  • Unexplained, persistent or recurrent fever (> 38 °C).
  • Severe night sweats (wet hair, soaked sleepwear).
  • Unwanted weight loss (> 10% percent of body weight within 6 months).

Extrapulmonary tuberculosis/extrathoracic tuberculosis

  • Tuberculosis most commonly becomes symptomatic at the postprimary tuberculosis stage (80% as pulmonary tuberculosis, 20% as extrapulmonary tuberculosis/extrathoracic tuberculosis). Postprimary tuberculosis is reactivated tuberculosis. The temporal latency can be several decades.
  • Up to 30% of all those with pulmonary tuberculosis also have intestinal (belonging to the intestinal tract) manifestations. Immunocompromised patients are particularly at risk (caveat: HIV).
  • In the majority of cases, extrathoracic tuberculosis (outside the chest) occurs in immunosuppressed patients in the context of severe disease progression by hematogenous seeding (“spread by blood“).
  • The extrapulmonary/extrathoracic form of tuberculosis often affects lymph nodes, the pleura (lung pleura) or the abdomen, here especially the genitourinary tract (urinary tract and genital organs). Furthermore, it may extrathoracic infestation of the CNS and musculoskeletal system.
  • The extrapulmonary/extrathoracic form of tuberculosis often affects lymph nodes, the pleura (lung pleura) or the abdomen (abdominal tuberculosis; in about 55-60% of cases as lymph node tuberculosis), here especially the genitourinary tract (with mostly unilateral kidney involvement). Furthermore, it can extrathoracic infestation of the CNS (in immunocompromised patients in 15% of all cases in the form of tuberculous meningitis / meningitis) and the musculoskeletal system (most common manifestation is tuberculous spondylitis / vertebral inflammation).