Pulmonary Disease

Classic symptoms include cough, fever, and sweating. Cough is nearly universal; typically, it is initially dry but then progresses with increasing volumes of purulent secretions and the variable appearance of blood streaking or gross hemoptysis. Feverishness is common as the disease advances, and actual temperatures range from subnormal to extreme elevations. Sweating, including drenching night sweats, is typical. Other common complaints include malaise, fatigue, weight loss, nonpleuritic chest pain, and dyspnea.

Signs may be limited until the disease is in advanced stages. Fever with peaks as high as 40 to 41° C, typically occurring in the evening, develops in patients with various forms and stages of tuberculosis. Localized rales are early findings, coarse rhonchi evolve as secretions become more voluminous and tenacious, and signs of lung consolidation are rarely heard. Wheezing or regionally diminished breath sounds, or both, may be heard in patients with peribronchial or endobronchial airway narrowing. Nevertheless, some patients with fairly extensive radiographic abnormalities may have minimal or no adventitious sounds on auscultation.