Multi-drug-resistant tuberculosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
A physical examination can provide valuable information about the patient’s overall condition and other factors that may affect how tuberculosis is treated, such as HIV infection or other illnesses. The most common physical findings include fever, decreased breath sounds, tachypnea and tachycardia. Physical findings will depend on the location of the tuberculosis infection.
Physical Examination
Pulmonary Tuberculosis
Physical findings for pulmonary tuberculosis include the following:[1]
Appearance of the Patient
Vitals
Lungs
- Decreased breath sounds
- Rales
- Rhonchi
- Bronchial breath sounds
Some patients with active tuberculosis might have a normal physical examination and further test need to be done to confirm the diagnosis.
Extra-Pulmonary Tuberculosis
All forms of extra-pulmonary tuberculosis can include findings of pulmonary tuberculosis such as cachexia, fever, tachypnea, tachycardia, and can be associated with an active pulmonary infection.
| Extra-Pulmonary Location | Additional Physical Examination Findings |
|---|---|
| Tuberculous Lymphadenitis | Cervical lymph node enlargement |
| Skeletal Tuberculosis | Low back pain, stiffness, tenderness, joint swelling and erythema, limited range of motion. |
| Central Nervous System Tuberculosis | Altered mental status, CN palsy (specially CN VI), papilledema, hemiparesis, hemiplegia, and nuchal rigidity. |
| Tuberculosis Peritonitis | Diffuse abdominal tenderness, ascites, fever. |
| Tuberculous Pericarditis | Tachycardia, pulsus paradoxus and hypotension (in cardiac tamponade), jugular venous distension with a prominent Y descent, Kussmaul's sign, pleural dullness, pericardial knock, pericardial rub,distant heart sounds, hepatomegaly, ascites, and ankle edema. |
| Renal Tuberculosis | Costo-vertebral angle tenderness (in UTI), lower abdominal tenderness (in obstructive uropathy), findings of renal insufficiency. |
| Adapted from Asian Spine J. Feb 2014; 8(1): 97–111[2]; Handbook of Clinical Neurology[3]; Circulation Dec 2005 vol.112 no.23 3608-3616[4]; Am J Trop Med Hyg 2013 vol. 88 no. 1 54-64[5] Clin Infect Dis.(2011)53(6):555-562.[6] | |
References
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Moon, Myung-Sang (2014). "Tuberculosis of Spine: Current Views in Diagnosis and Management". Asian Spine Journal. 8 (1): 97. doi:10.4184/asj.2014.8.1.97. ISSN 1976-1902.
- ↑ Garcia-Monco, Juan Carlos (2014). "Tuberculosis". 121: 1485–1499. doi:10.1016/B978-0-7020-4088-7.00100-0. ISSN 0072-9752.
- ↑ Mayosi, B. M. (2005). "Tuberculous Pericarditis". Circulation. 112 (23): 3608–3616. doi:10.1161/CIRCULATIONAHA.105.543066. ISSN 0009-7322.
- ↑ Daher, E. D. F.; da Silva Junior, G. B.; Barros, E. J. G. (2013). "Renal Tuberculosis in the Modern Era". American Journal of Tropical Medicine and Hygiene. 88 (1): 54–64. doi:10.4269/ajtmh.2013.12-0413. ISSN 0002-9637.
- ↑ Fontanilla, J.-M.; Barnes, A.; von Reyn, C. F. (2011). "Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis". Clinical Infectious Diseases. 53 (6): 555–562. doi:10.1093/cid/cir454. ISSN 1058-4838.