UMEM Educational Pearls

Title: Tuberculosis- Disease Recognition

Keywords: Tuberculosis, infectious diseases (PubMed Search)

Posted: 7/2/2015 by Jon Mark Hirshon, MD, MPH, PhD
Click here to contact Jon Mark Hirshon, MD, MPH, PhD

As noted in a previous pearl (see 1/7/2015), tuberculosis (TB), caused by Mycobacterium tuberculosis, is the second greatest infectious killer after HIV/AIDS globally. While the incidence and death rate from TB is decreasing, it is still a widespread problem.

9 million people fell ill with TB in 2013
1.5 million deaths
Most deaths (95%) occur in low- and middle-income countries
Among the top 5 causes of death in women aged 15 to 44

Mycobacterium tuberculosis primarily attacks the lungs. However, it can attack any part of the body such as the kidney, spine, and brain. TB is primarily spread person to person through the air, for example when a person with TB coughs, sneezes, speaks, or sings.

Once a person is infected with TB, the likelihood of developing disease is greater if the person:

Is HIV infected;
Has recently acquired TB infection (past 2 years);
Has other health problems, like diabetes, that impair the immune response;
Is a substance abuser (alcohol or illegal drugs);
Was not adequately treated in the past for TB.

Classic symptoms for pulmonary TB include:

A prolonged (> 3 weeks) bad cough
- coughing up blood or sputum
Pain in the chest
weakness/ fatigue
weight loss
anorexia
chills
fever
sweating at night

Other TB symptoms can also include:

Prolonged headaches and mental status changes (TB meningitis),
Prolonged back pain/stiffness leading to lower extremity paralysis, or single joint arthritis (skeletal TB)
Flank pain, frequent urination, scrotal mass or epididymo-orchitis, pelvic inflammatory disease (genitourinary TB)

Bottom line

In the emergency department, maintain a strong clinical awareness for tuberculosis for someone with night sweats, cough, chest pain, and intermittent fever lasting for 3 weeks or longer. In particular, consider this diagnosis for someone from a low- or middle-income country or if he or she is HIV positive.

Next time: Testing and treatment for TB.

Also see prior pearls on TB: Multidrug Resistant Tuberculosis (MDR TB) (1/21/2015), Tuberculosis (1/7/2015); XDR Tuberculosis (8/14/2013); PPD positive? Good news... (2/6/2013)

References

http://www.cdc.gov/tb/

http://www.cdc.gov/tb/topic/basics/default.htm

http://www.who.int/mediacentre/factsheets/fs104/en/

http://emedicine.medscape.com/article/230802-overview