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Section 3. Summaries of Infectious Diseases

Tuberculosis

Clinical Manifestations
Etiology
Definitions
Epidemiology
Diagnostic Tests
TREATMENT (SEE Table 3.82, P 688)
Isolation of the Hospitalized Patient
Tuberculosis Caused by M bovis
Control Measures

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CLINICAL MANIFESTATIONS

Tuberculosis disease is caused by infection with organisms of the Mycobacterium tuberculosis complex, which includes M tuberculosis, Mycobacterium bovis, and Mycobacterium africanum. M africanum is rare in the United States, and clinical laboratories do not distinguish it routinely. M bovis can be distinguished routinely, and although the spectrum of illness that is caused by M bovis is similar to that of M tuberculosis, the epidemiology, treatment, and prevention are distinct. Most infections caused by M tuberculosis complex in children and adolescents are asymptomatic. When tuberculosis disease does occur, clinical manifestations most often appear 1 to 6 months after infection and include fever, weight loss, or poor weight gain and possibly growth delay, cough, night sweats, and chills. Chest radiographic findings after infection range from normal to diverse abnormalities, such as lymphadenopathy of the hilar, subcarinal, paratracheal, or mediastinal nodes; atelectasis or infiltrate of a segment or lobe; pleural effusion; cavitary lesions; or miliary disease. Extrapulmonary manifestations include meningitis and granulomatous inflammation of the lymph nodes, bones, joints, skin, and middle ear and mastoid. Renal tuberculosis and progression to disease from latent tuberculosis infection ("adult-type pulmonary tuberculosis") are unusual in younger children but can occur in adolescents. In addition, chronic abdominal pain with intermittent partial intestinal obstruction can be present in disease caused by M bovis. Clinical findings in patients with drug-resistant tuberculosis disease are indistinguishable from manifestations in patients with drug-susceptible disease.


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ETIOLOGY

The agent is M tuberculosis complex, a group of closely related acid-fast bacilli (AFB): M tuberculosis, M bovis, and M africanum.


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Definitions