The clinical manifestations of tuberculosis depend on the site of infection. However, primary infection is usually pulmonary. M. tuberculosis produces following clinical syndromes: (a) pul-monary tuberculosis and (b) extrapulmonary tuberculosis.
Productive cough, fever, and weight loss are typical symptoms of pulmonary tuberculosis. Hemoptysis or chest pain, night sweats, fatigue, and anorexia are the other systemic manifes-tations. The sputum may be scanty or bloody and purulent and, as a result, is usually associated with cavitary lesions in the lung.
Pulmonary tuberculosis may manifest in various forms including progressive pulmonary disease, involvement of pleura, and reactivated pulmonary disease. Pulmonary com-plications include relapse, aspergillomas, bronchiectasis, bron-cholithiasis, and fibrothorax.
Extrapulmonary tuberculosis usually occurs as a result of spread of the bacilli through blood circulation during the initial stage of multiplication at the site of primary infection, i.e., lung. Depending on the site of infection, extrapulmonary infections may be: (a) genitourinary tuberculosis, (b) tuber-cular meningitis, (c) gastrointestinal tuberculosis, (d) skel-etal tuberculosis, (e) tubercular lymphadenitis, and (f) other conditions.
Genitourinary tuberculosis: Genitourinary tuberculosis isone of the most common extrapulmonary manifestations of tuberculosis. The typical symptoms include dysuria, increased frequency of urination, and flank pain. The condition in men may manifest as epididymitis or a growth in the scrotal area. In women, the condition may manifest as pelvic inflammatory disease. Genitourinary tuberculosis is responsible for approxi-mately 10% of sterility in women.
Tubercular meningitis: This is one of the most severe com-plications of tuberculosis. The condition may persist as head-ache, which is either intermittent or persistent.
Gastrointestinal tuberculosis: The clinical manifestation ofthe condition depends on the site affected in the gastrointes-tinal tract. For example, infection of stomach or duodenum manifests as abdominal pain mimicking peptic ulcer disease, whereas infection of large intestine manifests as pain in abdo-men, diarrhea, etc.
Skeletal tuberculosis: Spine is the most common site involvedin skeletal tuberculosis resulting in Pott’s disease.
Tubercular lymphadenitis: Tubercular lymphadenitis orscrofula most commonly involves the neck along the sterno-cleidomastoid muscle. The condition is usually unilateral, with little or no pain.
Other conditions: These include miliary tuberculosis, tuber-culosis of the skin, and tuberculosis of the middle ear and ocu-lar structures.