Clinical Manifestations of tuberculosis

Because the primary infection results in bacillemic dissemination, tuberculosis can involve extrathoracic as well as pulmonary or pleural sites. Hosts with more competent immunity tend to have disease limited to their lungs or other single sites, whereas hosts with less robust defenses have multifocal or disseminated disease.

Excluding patients with HIV infection, about 80% of adults have exclusively pulmonary parenchymal disease, 15% have disease at extrapulmonary sites, and approximately 5% have simultaneously active disease at intrathoracic and extrathoracic locations. Although most patients complain of feeling “feverish,” a substantial proportion do not have fever when measured.