Early symptoms or the first signs of active pulmonary tuberculosis can include fever, nighttime hyperhidrosis, weight loss, but pain in pulmonary tuberculosis occurs later - with coughing, deep inspiration, during sudden movements - if the inflammation spreads to the pulmonary membrane (pleura). Depending on the place of the lesion, dull pains in the chest can be felt in the shoulder and neck (from the side of the lesion), as well as under the ribs and in the heart.
Pain in pulmonary tuberculosis
Acute retrosternal pains are characteristic of pulmonary tuberculosis complicated by exudative inflammation of the pleura, as well as in the pleural air cavity (pneumothorax).
However, periodic blunt pains of this localization can be not only in the pulmonary form of tuberculosis, but also in tuberculosis of the intrathoracic lymph nodes, as well as in the case of tuberculous pericarditis.
Sore throat with tuberculosis
Approximately 2% of patients with active pulmonary tuberculosis have tuberculous infiltration of the larynx or tuberculosis of the upper respiratory tract, trachea and bronchi.
Hoarseness and sore throat in tuberculosis can be in patients with tonsil involvement in the absence of active pulmonary tuberculosis, although such clinical cases are rare. Nevertheless, any oropharyngeal structures can be affected: tongue, mucous membrane of cheeks, sky, tonsils, pharynx.
With active pulmonary tuberculosis and its progression, perspiration and sore throat are most often associated with tuberculosis of the pharynx, which is characterized by miliary, i.e. Similar to the millet grain granulomatous rashes on mucous membranes, fever, ptyalism (increased secretion of saliva), and dysphagia (impaired swallowing).
Headaches for tuberculosis
Phthisiatricians attribute persistent headaches in tuberculosis to symptoms of hematogenous dissemination of M. Tuberculosis of the meninges, leading to the development of a life-threatening condition known as meningeal tuberculosis or tuberculous meningitis.
The first signs of this type of tuberculosis - deterioration of health, febrile state, headaches; a few weeks later, nausea and vomiting appear, the headache is aggravated, photosensitivity may occur, as well as tension in the neck muscles.
Owing to the increase in the pressure of the cerebrospinal fluid and the accumulation of exudate between the brain envelopes, changes in the mental state are noted: confusion of consciousness, fits of irritability, drowsiness, fainting with loss of consciousness right up to coma.
Some patients with tuberculous meningitis develop a tumor-like formation called tuberculoma, which can cause symptoms similar to a stroke.
Pain in joints with tuberculosis
Articular tuberculosis - peripheral osteoarticular tuberculosis is a slowly progressing chronic disease accounting for approximately 1-3% of all cases of tuberculosis and up to 10% of cases of its extrapulmonary localization. Pain in joints with tuberculosis of this variety is the earliest manifestation of the disease, and fever and systemic symptoms are usually absent. But almost always there is a development of cold abscess - localized caseous necrosis without typical signs of inflammation. As a result of his breakthrough through soft tissues a fistula is formed.
It is believed that tuberculous arthritis is a consequence of the spread of the primary infectious focus in the bone to the joint, and nine cases out of ten suffer from a hip or knee joint. Previous traumatic injury may be a factor that activates persistent tuberculosis infection.
Ribs, sternoclavicular, sacroiliac and ankle joints can be affected. Sometimes one patient is affected by several bones and joints, and then it is a question of multifocal skeletal tuberculosis.
Back pain in tuberculosis
Back pain in tuberculosis is the most common sign of a spinal cord injury - spinal tuberculosis or tuberculosis spondylitis. The grip of the vertebrae is usually the result of the hematogenous spread of M. Tuberculosis into the dense vascular network of the spongy body of the vertebrae. First of all, the pain appears in the lumbar region and in the thoracic spine (against or without typical symptomatology).
The intensity of back pain in spinal tuberculosis is different, it can become stronger during movement and changes in the position of the body due to instability of the vertebrae (caused by their pathological subluxation) and mechanical compression of the nerve roots. Approximately 50% of patients with spinal tuberculosis have neurological manifestations.
Thus, neuralgic pain in the back with tuberculosis of the thoracic and cervical spine is accompanied by weakness and numbness of the upper and lower extremities; they can progress to full paraplegia (paralysis of the two extremities) or tetraplegia (paralysis of the lower and upper extremities). Paraplegia can be the result of compression of the spinal cord by a retrofaryngeal (pharyngeal) abscess that causes dysphagia, respiratory distress, or persistent hoarseness.
Also, paralysis can be the result of the destruction of intervertebral discs; edema of the spinal cord and necrosis of areas of its tissue (myelomalacia); tuberculous infiltration of meninges (tuberculous spinal leptomeningitis); infectious thrombosis or endarteritis of cerebrospinal vessels.
Weakness, numbness and pain in muscles with spinal tuberculosis are felt by patients with compression of the horse's tail (rootlets of lumbar and sacral nerves) due to the formation of a cold abscess around the vertebrae of the lumbar and sacral parts.
Tuberculosis of the urinary tract, in particular, ureteral involvement, causes persistent dull pain in the lumbar region. Pain is localized in patients with kidney tuberculosis. If one kidney is affected, the pain is one-sided. The launched disease with destruction and necrosis of tissues surrounding tuberculosis granulomas, leads to attacks of acute pain.