Tuberculosis (TB) is a bacterial infection. It most commonly causes a lung infection after a period of no disease activity, with symptoms such as coughing, chest pain, and fatigue.
In some cases, TB can spread to other organs and tissue throughout the body, causing additional symptoms depending on where it spreads.
There are three stages of TB infections in the lungs:
Primary TB infection
Latent TB infection
Active TB disease
TB further breaks down into two main types: pulmonary and extrapulmonary. Extrapulmonary further breaks down into several subtypes. Each stage, type, and subtype of TB can cause different symptoms.
Primary TB Infection
Primary TB infection occurs when the bacteria first enters the lungs through exposure to another person with TB. Your body's immune system works to capture and destroy the bacteria.
Although most people don't develop symptoms at this stage, primary TB infection can involve flu-like symptoms, such as:
Tiredness
Low fever
Cough
Latent TB Infection
The latent TB infection stage typically follows the primary TB infection stage. During this stage, the bacteria remains in the body, but the immune system prevents it from causing any further issues or symptoms. An estimated 13 million people in the United States are living with latent TB.
If your immune system is no longer able to contain the bacterial infection, it can turn into active TB disease.
Active TB Disease
Once your immune system can no longer contain the virus, you can develop active TB disease. Though it can occur immediately after coming into contact with the bacteria, it often takes months to years before TB develops into an active infection.
Active TB can affect the lungs (pulmonary) or other parts of the body (extrapulmonary). When a TB infection is active in the lungs, the symptoms can come on gradually.
The symptoms can include:
Cough
Chest pain
Coughing up mucus or blood
Loss of appetite
Pain with coughing or breathing
Tiredness
Fever
Chills
Night sweats
Weight loss
Generally feeling unwell
If active TB disease moves beyond the lungs, it can cause symptoms that include:
Chills
Fever
Night sweats
Tiredness
Generally feeling unwell
Weight loss
Loss of appetite
Pain near the infection site
In addition, you may experience symptoms related to what parts of the body TB affects. These are discussed more in the types of TB below.
As mentioned, TB breaks down into two main types: pulmonary (in the lungs) and extrapulmonary (outside the lungs).
The most common type is pulmonary. Extrapulmonary breaks down into several subtypes based on where in the body TB spreads.
TB typically starts in the lungs, but it can travel through the body to different organs and tissues. When this occurs, you may experience symptoms depending on where the bacteria takes hold.
Subtypes of extrapulmonary TB and their symptoms are explained below.
TB Meningitis
TB meningitis occurs when TB causes inflammation in the lining of your brain. About 1 to 6 percent of cases of extrapulmonary TB cause meningitis.
Symptoms associated with this type of TB can start with:
Fatigue
Low-grade fever
Personality changes
Minor headaches
Generally feeling unwell
As it progresses, it can cause:
Persistent headache
Nausea and vomiting
Loss of appetite
Aches and pains
Lethargy
Confusion
Seizures
Coma
Death (if untreated)
Skeletal TB
TB can spread to the bones.
Pott's disease is the most common type of TB to affect the bones. Like other forms of extrapulmonary TB, it starts in the lungs before moving on to the spine.
Symptoms can include:
Weakness in the arms and legs
Back pain
Loss of appetite
Neck pain
Unexplained weight loss.
Fever
Addison's Disease
Though uncommon in developed countries now because of advances in treatments, TB can directly affect the adrenal gland, causing it to produce too little of the hormone cortisol and sometimes too little of the hormone aldosterone.
In early stages, Addison's disease can cause symptoms such as:
Fatigue
Sweating due to low sugar levels
Muscle cramps and weakness
Vomiting, diarrhea, or upset stomach
Fainting or dizziness
Pain in your abdomen
Weight loss due to reduced hunger
Loss of body hair
Salt cravings
Depression
Irritable mood
Lower sex drive (typically in women)
If any of these symptoms worsen, such as loss of consciousness or severe pain, you should seek emergency services for treatment.
Liver TB
When TB affects the liver, it can cause liver inflammation known as hepatitis.
Symptoms of hepatitis can include:
Fatigue
Diarrhea
Nausea
Loss of appetite
Pain on the upper right side of your belly
Weakness or general discomfort
Jaundice (yellowing of the skin and eyes)
TB Lymphadenitis
TB can affect your lymph nodes, causing swelling.
It often affects the lymph nodes in your neck causing a condition known as scrofula. Only about 5 percent of TB cases involve scrofula.
In addition to swelling in your neck, you may also develop:
Unintentional weight loss
Fatigue
Fever
Night sweats
Cutaneous TB
Cutaneous TB is a rare form of extrapulmonary TB, accounting for about 1.5 to 3 percent of all extrapulmonary cases worldwide.
Cutaneous TB can cause various lesions to appear on the skin. These can include:
Ulcers
Nodules
Plaques
Abscesses
Papules
You may develop a combination of the different skin lesions.
TB Pericarditis
TB can spread to the two thin layers of tissue surrounding and supporting your heart known as the pericardium. TB accounts for about 1 to 2 percent of all pericarditis.
The most common symptom is sharp chest pain that can spread to other areas, such as the left shoulder or neck. It may also worsen with coughing, lying down, or taking a deep breath. Sitting up can often relieve the pain.
Other symptoms can include:
Fever
Sweating at night
Tiredness
Decrease in weight
Coughing
Shortness of breath
Abdominal TB
Abdominal TB affects the gastrointestinal tract, peritoneum (thin layer of tissue surrounding the abdomen), intra-abdominal lymph nodes, and abdominal organs. It accounts for about 6 to 13 percent of all extrapulmonary cases of TB worldwide.
Symptoms are often nonspecific (very general), which can lead to delayed diagnosis. Symptoms can include:
Weight loss
Fever
Abdominal pain
Bowel habit changes
Genitourinary TB
Genitourinary TB affects both men's and women's bladder, kidneys, ureters, and genitalia. It accounts for about 20 percent of all extrapulmonary TB cases.
Symptoms can vary based on the exact parts affected, but often include nonspecific symptoms that may mimic other conditions, like urinary tract infections. Some possible symptoms include:
Painful urination
Ulcers on the genitals
Increased frequency of urination
You are not as likely to develop more common nonspecific symptoms of TB, such as fever, night sweats, or weight loss.
Miliary TB
Miliary TB is a type of pulmonary and extrapulmonary TB that occurs when the bacteria gets into the bloodstream and causes an infection in multiple parts of the body. This is most common in infants, children under 5, and people with severely weakened immune systems, but anyone can contract it.
It gets its name from a Latin word meaning “millet seeds” because of the small lesions that appear on the organs it affects. Symptoms generally start as nonspecific and can go on to include site-specific symptoms. Symptoms include:
Fever
General weakness
Anorexia
Weight loss
Lack of energy
Chest pain
Trouble taking deep breaths
Abdominal pain
Nausea
Vomiting
TB can cause a variety of complications, depending on which organs are affected, and can be life-threatening if not treated. Factors that affect what complications you experience can include:
Extent of an organ's involvement
Side effects of medications
Socioeconomic status and access to healthcare
A weakened immune system
TB can cause several nonspecific symptoms. They can also vary based on where the TB infection occurs. You should consider seeing your doctor if you experience symptoms that do not improve or get worse after a few days, particularly if you do not know the cause.
You should seek emergency or urgent care if you experience any of the following:
Blood in your stool or urine
Seizures
Coughing up blood
Chest pain
Trouble breathing
Severe headache that comes on suddenly
Confusion
TB may affect the lungs (pulmonary) or other areas of the body (extrapulmonary), causing different symptoms based on the location of the infection.
Pulmonary TB is the most common type and causes symptoms such as chest pain, coughing, fatigue, weight loss, and coughing up blood.
Extrapulmonary TB can cause nonspecific symptoms, such as fatigue, generally feeling unwell, and fever. It can also cause symptoms based on where the infection occurs, such as sharp chest pain if it affects the protective layer around your heart.
