Primary TB Infection The bacteria enter your body after exposure to someone with active TB. This is the initial TB infection in a person who has not been exposed to the bacteria before. It can be asymptomatic (without showing signs), or you may experience fever or pulmonary symptoms. In most people, the immune system kicks in, and they recover from this infection, but the bacteria can remain latent in the body.Latent TB Infection The bacteria are in the body and can be found through tests, but they’re not multiplying. During this stage, people don’t experience symptoms, and they can’t spread the disease to others.Active Disease The TB bacteria are active and multiplying. This is when symptoms start to show up. A person will feel sick and can spread the disease to others.
The bacteria that cause TB multiply very slowly, so the symptoms of the disease also develop slowly, usually over months to years. And because many of the symptoms are vague and can have other causes, they are often not recognized as early symptoms of tuberculosis. For example, someone with a cough may ignore it because they think it’s related to asthma or allergies. (2,3) The general symptoms of active tuberculosis include these signs: (2,3,4)
A general sense of being unwellCoughingCoughing up blood or phlegmChest painTrouble breathingLoss of weight and appetiteNight sweatsIntermittent feverGeneralized body achesFatigue
If you experience any of these symptoms, see your doctor. People at a high risk, such as those with HIV and healthcare workers who are likely to treat someone with active TB, should be screened for infection. (1) Since TB symptoms can have other explanations, Asim A. Jani, MD, MPH, the medical director for communicable diseases at the Florida Department of Health in Orange County, recommends diagnostic tests for anyone who has any TB symptoms as well as a history of TB risk factors. Once the TB bacteria gets into your body, it enters the lungs first, but once it’s active, it can spread to the lymph nodes (glands that protect your body from disease) and other areas of the body. Tuberculosis most commonly affects the lungs, a condition called pulmonary tuberculosis. When it affects parts of the body besides the lungs, it’s called extrapulmonary tuberculosis. This is more common in people with weakened immune systems that can’t contain the infection to one area. (4)
What Is Pulmonary Tuberculosis?
Pulmonary tuberculosis starts with a cough that won’t go away and worsens over time. At first, the cough may produce yellow or green sputum (phlegm) first thing in the morning. The cough is often blamed on smoking, asthma, or a recent illness rather than recognized as a symptom of TB. Eventually, the sputum may be streaked with blood, although large amounts of blood are unusual. (2,3,5) The TB bacteria damage the lungs, making them unable to bring enough oxygen to the blood. When the body doesn’t get enough oxygen, it can’t function properly. As the infection progresses, people feel tired and generally unwell. They may lose weight due to loss of appetite. Before tuberculosis was scientifically understood, it was known as “consumption” because those with the disease looked like they were being consumed as they got pale, weak, and thin. (5) Pulmonary tuberculosis can also cause night sweats, which is when a person wakes up drenched in sweat. It may or may not cause a fever. Two other common symptoms of pulmonary tuberculosis are chest pain and shortness of breath. These symptoms may result from pleural effusion (a buildup of fluid between the thin membranes, the pleura, that cover the lungs and line the inside of the chest wall). Or they can be a sign of a pneumothorax (the presence of air between the pleura). Pulmonary tuberculosis can have long-term complications as well. As the bacteria harm the lungs, you are at risk for other conditions — even after successful TB treatment. (6) Long-term complications from pulmonary TB can include these conditions:
Scarred lung tissueNarrowed airways (airway stenosis)Chronic obstructive pulmonary diseaseLung cancer
What Is Extrapulmonary Tuberculosis?
Extrapulmonary tuberculosis happens when pulmonary TB spreads from the lungs and travels to other parts of the body through the bloodstream. This type of tuberculosis can be difficult to diagnose and is often mistaken for another condition or illness at first. Very young children and people who have HIV/AIDS are at a higher risk of developing extrapulmonary tuberculosis because their immune systems are weaker, but anyone with untreated active TB can develop it. (7,8,9) After declining for years, tuberculosis rates in the United States went up again in the 1980s during the HIV/AIDS epidemic. Rates of extrapulmonary tuberculosis also increased. Because HIV and AIDS weaken the immune system, TB can spread more aggressively. TB infections outside the lungs are less common in the United States today but can be very serious. (9) The symptoms depend on where the active disease has spread.
Abdominal cavity: swelling and tendernessBladder: painful or frequent urination, and blood in the urineBones: pain, tenderness, and tuberculosis arthritisHead: headache that won’t go away, nausea, drowsiness, mental changes, confusion, a stiff neck, and seizuresJoints: pain, stiffness, swelling, and loss of movement in the affected jointsKidneys: pain, blood in the urine, and frequent urinationLymph nodes: redness, swelling, and tendernessPericardium (the membrane around the heart): enlarged neck veins, shortness of breath, and chest painReproductive organs (men): lump in scrotumReproductive organs (women): infertility, pelvic pain, and abnormal bleeding
What Is Pott’s Disease and Who Is At Risk?
Pott’s disease, or Pott disease or Pott’s spine, is the term for tuberculosis that has spread to the spine. About 2 percent of all TB cases and 15 percent of extrapulmonary TB cases are spinal. Today, it’s uncommon in developed countries, but Pott’s disease is still a concern in areas of the world with high TB rates and poor access to quality healthcare. (9,10) People with spinal TB will experience general TB symptoms with additional symptoms related to Pott’s disease. Like pulmonary TB, it spreads slowly, which means it can take weeks or years to diagnose properly. (10) Symptoms of Pott’s disease include the following:
Back pain that gets worse over timeMuscle spasmsTrouble movingCollapsed vertebraeNerve painParalysisDeformed spine
How Tuberculosis Can Cause a Form of Meningitis
Tuberculosis can lead to meningitis if the bacteria spread to the brain and spine. Although it’s rare in the United States, tuberculous meningitis is a serious condition that’s life-threatening if not treated. People with weakened immune systems are more likely to develop meningitis. The disease can also appear as part of an extrapulmonary TB infection or on its own. (11,12) Tuberculous meningitis starts slowly. Common symptoms include the following:
FeverChillsReally bad headacheNausea and vomitingStiff neckLight sensitivityChanges in your mental status, like being confused or disoriented
Other possible symptoms:
Losing consciousnessFeeling agitated or restlessNot eating or being irritable (most common in children)Bulging soft spots on head and/or posture in which the neck is arched back (usually in babies and infants)
What Is Miliary Tuberculosis and Who Is At Risk?
Miliary TB, or disseminated tuberculosis, is a potentially life-threatening form of the infection in which large numbers of TB bacteria spread all over the body through the bloodstream. The term was coined by a doctor in the 1700s, who compared the diseased lung to millet seeds because its surface was covered in small, hard white nodules. Late in the course of the disease, a chest X-ray of miliary TB shows millions of tiny spots throughout the lungs. (13) The symptoms of miliary TB are the same as those seen in other types — fatigue, weight loss, fever, chills, weakness, and difficulty breathing — making it difficult to diagnose. Night sweats are common with miliary TB and can be so severe that a person will wake up with a damp silhouette on their sheets. In rare cases, a painful rash may also develop. (13,14) Like forms of TB that spread throughout the body, it’s also more common in people with a weakened immune system. People with HIV/AIDS or another condition that compromises the immune system and young children are at a higher risk of getting miliary TB. Additional reporting by Ingrid Strauch.
