TB Signs and Symptoms

Patients with tuberculosis may present without symptoms or may present in an extremely debilitated state. Symptom-free TB may be detected during routine screening. Symptoms of tuberculosis may include malaise, weight loss, and night sweats. Most patients with TB have pulmonary disease; extrapulmonary disease usually is seen in immunocompromised patients.

TB in patients infected with HIV may present atypically. These patients have a higher risk for developing multidrug-resistant TB (MDR-TB) and miliary TB. Usually, a longer course of therapy is needed and, because of interactions with other medications, the regimen may require adjustment.

TB symptoms include:

  • cough that is worse in the morning (sometimes with hemoptysis, blood in the sputum),
  • chest pain,
  • breathlessness,
  • night sweats, and
  • signs of pneumonia.

In advanced disease, there may be extreme weight loss. Examination with a stethoscope may reveal diminished breath sounds, bronchial breathing, tracheal deviation, and coarse crackles.

Tuberculosis is difficult to diagnose because the signs and symptoms are similar to those caused by other diseases, such as the following:

  • Lung cancer (carcinoma of the lung, frequently creates cavities in lung tissue)
  • Pneumonia (can proceed to cavitation and resemble TB on chest x-ray)
  • Allergic bronchopulmonary asperigollosis (marked by inflammatory granulomatous lesions in bronchi)
  • Sarcoidosis, allergic alveolitis, pneumoconiosis, silicosis (biopsy and allergy screening eliminate these from diagnosis; silicosis predisposes to tuberculosis)
  • Anorexia nervosa, diabetes mellitus, hyperthyroidism (chronic malaise, fatigue and cachexia [wasting])
  • Mediastinial lymphadenopathy (may also be lymphoma)

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 31 May 2000

Last Modified: 08 Oct 2015