Clinical manifestations-Screening for latent TB

(Lancet 2016;387:1211)

• Constitutional symptoms are common in all manifestations, but may be absent
• Primary TB pneumonia:
  • middle or lower lobe consolidation,
  • ± effusion,
  • ± cavitation
• TB pleurisy:
  • pulmonary effusion
  • ± pericardial and peritoneal effusions secondary to granuloma breakdown and local inflammation;
  • can occur in primary or reactivation
• Reactivation TB pulmonary disease:
  • upper lobe infiltrate
  • ± volume loss
  • ± cavitation
• Milliary TB:
  • diffuse millet seed-sized lesions,
  • more common in immunosupp.
• Extrapulmonary TB:
• TB and HIV:
  • HIV ⊕ at ↑ risk infxn,
  • reactivation (8–10%/yr without ART, higher w/ ↓ CD4),
  • and progressive 1° infxn.
  • CXR can be atypical espec.
    • if CD4 ≤200 (JAMA 2005;293:2740).