Infectious diseases specialists diagnose and treat infections from bacteria, viruses, fungi, and parasites, focusing on fevers, antibiotics, and vaccines.
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The symptomatology of active pulmonary tuberculosis is often insidious, developing gradually over weeks or months. This slow progression frequently leads to delays in seeking medical attention, allowing the disease to advance and transmission to continue unchecked. The hallmark symptom is a persistent cough lasting more than 3 weeks. Initially, this cough may be dry and non-productive, resulting from mild inflammation of the bronchial mucosa. As the disease progresses and tissue necrosis occurs within the granulomas, the cough becomes productive. The patient begins to expectorate sputum—a mix of mucus, inflammatory cells, and necrotic lung tissue. In advanced cases, the erosion of blood vessels within the lung cavities leads to hemoptysis, the coughing up of blood. This alarming symptom ranges from blood-streaked sputum to massive pulmonary hemorrhage, signaling substantial tissue destruction.
Accompanying the respiratory symptoms is a constellation of systemic, or constitutional, symptoms that reflect the chronic inflammatory state. Fever is common but typically low-grade and fluctuating, often rising in the late afternoon or evening. This is frequently associated with drenching night sweats, a classic sign in which the patient wakes up with bedclothes soaked in perspiration, independent of ambient temperature. Unintentional weight loss and anorexia (loss of appetite) are also prominent features, earning the disease its historical moniker “consumption,” as the chronic infection consumes the body’s metabolic reserves. Profound fatigue and malaise are nearly universal, debilitating the patient and affecting their ability to perform daily activities.
Chest pain in pulmonary TB is often pleuritic—a sharp, stabbing pain that worsens with deep breathing or coughing. This indicates that the inflammatory process has extended to the pleura, the double-layered membrane surrounding the lungs. In some cases, fluid accumulation in the pleural space (pleural effusion) can cause significant breathlessness (dyspnea) by compressing lung tissue and restricting lung expansion.
When Mycobacterium tuberculosis disseminates beyond the lungs, symptoms depend on the organ system involved. This protean nature of TB makes it a “great imitator” in clinical medicine.
Transmission of tuberculosis is exclusively airborne, driven by the physics of aerosols. The process begins when an individual with active pulmonary or laryngeal TB forcefully exhales through coughing, sneezing, shouting, or singing. This action aerosolizes respiratory secretions into microscopic droplets. The larger droplets settle quickly due to gravity. Still, the smaller droplets—known as droplet nuclei (1 to 5 microns in diameter)—rapidly evaporate, leaving behind the lightweight bacterial cargo suspended in the air.
These droplet nuclei are buoyant and can traverse significant distances on air currents, remaining suspended and infectious for hours. Transmission occurs when a susceptible individual inhales these droplet nuclei. Crucially, the particles must be small enough to bypass the upper respiratory defense mechanisms (the nose, throat, and cilia) and deposit deep within the alveoli of the lungs. It is only in the alveoli that macrophages can take up the bacteria to initiate infection.
TB is not spread by surface contact. You cannot contract TB by shaking hands, sharing food or drink, touching bed linens or toilet seats, or kissing. The transmission requirement is the inhalation of the specific airborne particle. This distinction is vital for infection control protocols, which emphasize ventilation and air filtration rather than surface disinfection.
The likelihood of transmission is determined by a complex equation involving the source case, the environment, and the host.
Children present a unique profile in TB transmission. Young children with pulmonary TB are generally less infectious than adults. This is because their cough is often weaker, lacking the force to generate significant aerosols, and they tend to swallow sputum rather than expectorate it. Furthermore, children are usually paucibacillary, meaning they harbor fewer bacteria. Consequently, pediatric TB is typically a sentinel event indicating recent transmission from an infectious adult within the household or community, rather than the child being a primary source of community spread. However, adolescents tend to develop adult-type disease and can be as infectious as adults.
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The timeline varies significantly. After infection, the immune system may contain the bacteria, leading to latent TB with no symptoms for years or decades. If the immune system fails to clear the initial infection, active disease symptoms can develop within weeks to months. The risk of developing active disease is highest in the first two years following infection.
No, tuberculosis is not spread through saliva, sharing food or drinks, or touching surfaces like cutlery or glasses. The bacteria must be inhaled into the lungs via microscopic airborne particles. It requires the specific mechanism of aerosolization and inhalation to establish an infection.
Night sweats associated with TB are typically severe and drenching, often requiring the patient to change bedclothes or sheets. They occur independently of the room temperature or the amount of blankets used. This symptom is a systemic response to the chronic inflammatory factors released by the immune system as it fights the bacteria.
Compared to highly contagious viruses like measles or the flu, TB is relatively difficult to catch. It usually requires prolonged and close contact with an infectious person in a poorly ventilated space. Brief or casual contact is unlikely to result in transmission, as the contagious dose required is generally higher or requires accumulation over time.
Coughing up blood, or hemoptysis, occurs when the TB infection destroys lung tissue and erodes into the blood vessels within the lungs. As the cavities form and expand, they can breach bronchial arteries, causing blood to leak into the airways, which is then coughed up. This is a sign of advanced tissue damage.
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