Tuberculosis

== Signs and symptoms ==

[[File:Tuberculosis symptoms.svg|thumb|upright=1.5|The main symptoms of variants and stages of tuberculosis are given,<ref>{{cite web|url=http://www.emedicinehealth.com/tuberculosis/page3_em.htm|title=Tuberculosis Symptoms|publisher=eMedicine Health| vauthors = Schiffman G |date=15 January 2009|url-status=live|archive-url=https://web.archive.org/web/20090516075020/http://www.emedicinehealth.com/tuberculosis/page3_em.htm|archive-date=16 May 2009}}</ref> with many symptoms overlapping with other variants, while others are more (but not entirely) specific for certain variants. Multiple variants may be present simultaneously.]]
Tuberculosis may infect any part of the body, but most commonly occurs in the lungs (known as pulmonary tuberculosis).<ref name=ID10/> Extrapulmonary TB occurs when tuberculosis develops outside of the lungs, although extrapulmonary TB may coexist with pulmonary TB.<ref name=ID10/>

General signs and symptoms include fever, [[chills]], night sweats, [[Anorexia (symptom)|loss of appetite]], weight loss, and [[fatigue (medical)|fatigue]].<ref name=ID10/> Significant [[nail clubbing]] may also occur.<ref name="Pet2005">{{cite book|url=http://www.wiley.com/WileyCDA/WileyTitle/productCd-072791605X.html|title=Evidence-Based Respiratory Medicine|date=2005|publisher=BMJ Books|isbn=978-0-7279-1605-1|veditors=Gibson PG, Abramson M, Wood-Baker R, Volmink J, Hensley M, Costabel U|edition=1st|page=321|archive-url=https://web.archive.org/web/20151208072842/http://www.wiley.com/WileyCDA/WileyTitle/productCd-072791605X.html|archive-date=8 December 2015|url-status=live}}</ref>

=== Pulmonary ===

If a tuberculosis infection does become active, it most commonly involves the lungs (in about 90% of cases).<ref name=Lancet11/><ref>{{cite book| vauthors = Behera D |title=Textbook of Pulmonary Medicine|year=2010|publisher=Jaypee Brothers Medical Publishers|location=New Delhi|isbn=978-81-8448-749-7|page=457|url=https://books.google.com/books?id=0TbJjd9eTp0C&pg=PA457|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20150906185549/https://books.google.com/books?id=0TbJjd9eTp0C&pg=PA457|archive-date=6 September 2015}}</ref> Symptoms may include [[chest pain]] and a prolonged cough producing sputum.<!-- <ref name=Lancet11/> --> About 25% of people may not have any symptoms (i.e., they remain asymptomatic).<ref name=Lancet11/> Occasionally, people may [[hemoptysis|cough up blood]] in small amounts, and in very rare cases, the infection may erode into the [[pulmonary artery]] or a [[Rasmussen's aneurysm]], resulting in massive bleeding.<ref name=ID10/><ref>{{cite journal | vauthors = Halezeroğlu S, Okur E | title = Thoracic surgery for haemoptysis in the context of tuberculosis: what is the best management approach? | journal = Journal of Thoracic Disease | volume = 6 | issue = 3 | pages = 182–85 | date = March 2014 | pmid = 24624281 | pmc = 3949181 | doi = 10.3978/j.issn.2072-1439.2013.12.25 }}</ref> Tuberculosis may become a chronic illness and cause extensive scarring in the upper lobes of the lungs.<!-- <ref name=ID10/> --> The upper lung lobes are more frequently affected by tuberculosis than the lower ones.<ref name=ID10/> The reason for this difference is not clear.<ref name="Robbins" /> It may be due to either better air flow,<ref name="Robbins" /> or poor [[lymph]] drainage within the upper lungs.<ref name=ID10/>

=== Extrapulmonary ===
{{Main|Extrapulmonary tuberculosis}}
In 15–20% of active cases, the infection spreads outside the lungs, causing other kinds of TB.<ref>{{cite book| veditors = Jindal SK |title=Textbook of Pulmonary and Critical Care Medicine|publisher=Jaypee Brothers Medical Publishers|location=New Delhi|isbn=978-93-5025-073-0|page=549|url=https://books.google.com/books?id=EvGTw3wn-zEC&pg=PA549|year=2011|url-status=live|archive-url=https://web.archive.org/web/20150907185434/https://books.google.com/books?id=EvGTw3wn-zEC&pg=PA549|archive-date=7 September 2015}}</ref> These are collectively denoted as extrapulmonary tuberculosis.<ref name=Extra2005>{{cite journal | vauthors = Golden MP, Vikram HR | title = Extrapulmonary tuberculosis: an overview | journal = American Family Physician | volume = 72 | issue = 9 | pages = 1761–68 | date = November 2005 | pmid = 16300038 }}</ref> Extrapulmonary TB occurs more commonly in people with a [[Immunosuppression|weakened immune system]] and young children. In those with HIV, this occurs in more than 50% of cases.<ref name=Extra2005/> Notable extrapulmonary infection sites include the [[Pleural cavity|pleura]] (in tuberculous pleurisy), the [[central nervous system]] (in [[tuberculous meningitis]]), the [[lymphatic system]] (in [[Tuberculous cervical lymphadenitis|scrofula]] of the neck), the [[genitourinary system]] (in [[urogenital tuberculosis]]), and the [[bone]]s and joints (in [[Pott disease]] of the spine), among others. A potentially more serious, widespread form of TB is called "disseminated tuberculosis"; it is also known as [[miliary tuberculosis]].<ref name=ID10/> Miliary TB currently makes up about 10% of extrapulmonary cases.<ref name=Gho2008/>
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