Search
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/topic/basics/default.htm
http://www.who.int/mediacentre/factsheets/fs104/en/
http://emedicine.medscape.com/article/230802-overview