Clinical Manifestations

Tuberculosis can be divided into two stages; latent and active. Latent stage
shows no clinical symptoms. Meanwhile, the active stage shows several clinical
manifestations based on the sites of infection mainly pulmonary and
extrapulmonary.1 Development of tuberculosis among patients may vary due to
immune status and various cellular processes.2 Each stage of tuberculosis has
different clinical manifestations.
a. Latent Tuberculosis
At this stage, there are no clinical symptoms found as well as radiological
or microbiological evidence of the disease.3 This stage occurs when the pathogen
resides and stay dormant inside the host’s body. However, it may progress and
become active during the lifetime of individual if immune system becomes
compromised.
b. Primary Disease
From the latent stage, the pathogen may become active yet often
asymptomatic with some self-limiting clinical findings. 2 As an example, pleural
effusion may occur due to bacterial infiltration of pleural space and cause
symptoms such as chest pain, fever, and dyspnea.
c. Primary Progressive Tuberculosis
The growth and multiplication of bacteria in the host is referred as active
disease, due to the failure of immune system to contain the infection. According
to CDC, pulmonary TB may cause symptoms such as persistent bad cough (3
weeks) with sputum or blood (hemoptysis) and also pain in the chest.4
Other symptoms include weakness or fatigue, weight loss, loss of appetite,
chills, fever, and sweating at night.
d. Extrapulmonary Tuberculosis
Extrapulmonary tuberculosis (EPTB) is defined as any site of infection in
the body other than the lung parenchyma. This results from the hematogenous and
lymphatic spread of the pathogen.5 The most common form of EPTB and occurs
due to infection of lymph nodes is lymph node tuberculosis. 6 This type of EPTB
mainly affects children and young adults presenting with enlarged lymph nodes
and are usually asymptomatic. The most common location is cervical lymph
nodes, followed by supraclavicular, axillary, thoracic, and abdominal nodes.7
Another common type is pleural tuberculosis, also called as tuberculous
pleurisy. The symptoms manifest as chest pain, cough, acute illness with fever,
and pleural effusion. Genitourinary tuberculosis commonly affects kidneys and
also genitals that may lead to infertility. This type of tuberculosis shows non-
specific symptoms with serious complications such as kidney failure.1
A study in Brazil mentioned that multidrug-resistant tuberculosis (MDR-
TB) may present with symptoms such as productive cough without fever, fatigue,
and weight loss.8

Daftar Pustaka
1. Joon D, Nimesh N, Nimesh M. Clinical manifestations of tuberculosis.
Voyager. 2017 Jun;8(1):37-46.
2. Knechel NA. Tuberculosis: pathophysiology, clinical features, and
diagnosis. Critical Care Nurse. 2009 April;29(2):34-43.
3. Lee SH. Diagnosis and treatment of latent tuberculosis infection. Tuberc
Respir Dis (Seoul). 2015 Apr;78(2):56-63.
4. CDC. Basic tb facts: signs & symptoms [Online]. CDC; 2016 [updated
2016 Mar 17; cited 2018 Nov 6]. Available from:
https://www.cdc.gov/tb/topic/basics/signsandsymptoms.htm
5. Polena H, Boudou F, Tilleul S, Dubois-Colas N, Lecointe C,
Rakotosamimanana N, et al. Mycobacterium tuberculosis exploits the
formation of new blood vessels for its dissemination. Sci Rep [Internet].
2016 Sep;6:33162. Available from:
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6. Fontanilla JM, Barnes A, von Reyn CF. Current diagnosis and
management of peripheral tuberculous lymphadenitis. Clin Infect Dis
[Internet]. 2011 Sep;53(6):555-62. Availbable from:
https://www.ncbi.nlm.nih.gov/pubmed/21865192 DOI: 10.1093/cid/cir454
7. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR.
Epidemiology of extrapulmonary tuberculosis in the united states, 1993-
 2006. Clin Infect Dis [Internet]. 2009 Nov;49(9):1350-7. Available from:
https://www.ncbi.nlm.nih.gov/pubmed/19793000 DOI: 10.1086/605559
8. Micheletti VCD, Kritski AL, Braga JU. Clinical features and treatment
outcomes of patients with drug-resistant and drug-sensitive tuberculosis: a
historical cohort study in porto alegre, brazil. PLoS ONE [Internet]. 2016
Aug;11(8):e0160109. Available from: DOI:
10.1371/journal.pone.0160109