Symptoms

A chronic productive cough, shortness of breath, weight loss, fever, night sweats and fatigue are the classic symptoms of pulmonary tuberculosis. However, these symptoms can also have several alternative causes in people with HIV.

In people with severe immune damage or in infants, tuberculosis can spread or 'disseminate' from the lungs to other organs. This is often called 'atypical' or 'extrapulmonary' tuberculosis. While symptoms such as fever, fatigue and weight loss are fairly constant, other symptoms depend on where the infection spreads to.

Extrapulmonary conditions include:

• Tuberculous lymph node disease.

• Bone and joint tuberculosis or 'osteitis'. Spine involvement (myelopathy) is particularly dangerous.

• Pericardial tuberculosis: inflammation of soft tissue surrounding the heart. The condition puts great stress on the heart.

• Pleural tuberculosis: infection of the membrane surrounding the lungs.

• Tuberculosis peritonitis: tuberculosis in the abdomen and gut, with swollen lymph nodes and liver. Lymph nodes sometime adhere to the bowel causing obstructions or fistulae (abnormal passages) between the bowel, bladder and abdominal walls.

• Genitourinary tuberculosis: in the kidneys and urinary tract.

• Tuberculosis meningitis: inflammation of the spinal cord or brain. This begins with irritability, sleeplessness, a stiff neck with headache that grows more severe, with increasing drowsiness. It can lead to confusion or delirium, possible convulsions and decreased consciousness leading to coma or death.

• Disseminated or 'miliary' tuberculosis: a generalised systemic disease often with small nodules in affected organs and tissue.