TUBERCULOSIS - CLINICAL PRESENTATION, EXAMINATION AND INVESTIGATION

TUBERCULOSIS - CLINICAL PRESENTATION, EXAMINATION AND INVESTIGATION

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis. It primarily affects the lungs (pulmonary TB), but may also involve other organs (extrapulmonary TB). In Ayurveda, it can be correlated with Rajayakshma, a disease caused by simultaneous aggravation of all three doshas, with dhatu-kshaya as the main feature.

CLINICAL PRESENTATION OF TUBERCULOSIS

1. AYURVEDIC PERSPECTIVE – RAJAYAKSHMA LAKSHANA

As per Charaka Samhita, Rajayakshma presents with six main symptoms.

श्वासः कासो विवर्णत्वं क्षयं ज्वर अनन्नता।
सप्ताहत्वान्निमित्तत्वाच्छोकाच्चापि यथाक्रमम्॥
(Cha. Chi. 8/9)

Classical Features (Shad Rupa of Rajayakshma):

• Shwasa – Breathlessness

• Kasa – Cough

• Jwara – Fever (especially low-grade, evening rise)

• Anannabhilasha – Loss of appetite

• Kshaya – Emaciation, weight loss

• Vivrana Twak – Discoloration of skin

Additional features:

• Night sweats

• Hoarseness of voice

• General debility

• Hemoptysis in advanced stage

2. MODERN CLINICAL FEATURES – PULMONARY TB

• Persistent cough for more than 2–3 weeks

• Sputum production (may be blood-stained)

• Low-grade evening rise of temperature

• Night sweats

• Weight loss

• Fatigue and weakness

• Chest pain, breathlessness (in progressive disease)

EXTRAPULMONARY TB manifestations depend on the organ involved:

• Lymph node TB: Painless lymphadenopathy

• TB meningitis: Headache, neck stiffness, altered sensorium

• TB spine: Back pain, deformity

• Abdominal TB: Pain, distension, altered bowel habits

CLINICAL EXAMINATION OF TUBERCULOSIS

1. GENERAL EXAMINATION

• Pallor – Due to anemia

• Weight loss – Emaciated appearance

• Fever – Low grade, especially in the evening

• Pulse – May be rapid

• Lymphadenopathy – Especially cervical nodes

• Sweating – Noted particularly at night

2. RESPIRATORY SYSTEM EXAMINATION

• Inspection: Flattened chest, use of accessory muscles, intercostal retractions

• Palpation: Reduced chest expansion, tactile fremitus

• Percussion: Dullness over areas of consolidation/cavitation

• Auscultation: Bronchial breath sounds, crepitations, or amphoric breathing in cavitary lesions

3. EXAMINATION FOR EXTRAPULMONARY TB

• CNS TB: Meningeal signs

• Abdominal TB: Guarding, rigidity, ascites

• Spinal TB: Tenderness, gibbus deformity

• Genitourinary TB: Flank pain, hematuria

RELEVANT INVESTIGATIONS OF TUBERCULOSIS

1. MICROBIOLOGICAL TESTS

• Sputum Smear Microscopy (Ziehl-Neelsen staining):
  Detects acid-fast bacilli (AFB)

• CBNAAT (GeneXpert):
  Detects M. tuberculosis DNA and rifampicin resistance

• Culture (Löwenstein-Jensen medium):
  Gold standard for diagnosis

• Line Probe Assay (LPA):
  Rapid molecular test for drug resistance

2. RADIOLOGOICAL INVESTIGATIONS

• Chest X-Ray:

  • Infiltrates in upper lobes

  • Cavitary lesions

  • Fibrosis, nodular shadows

  • Hilar lymphadenopathy

• Ultrasound abdomen (for extrapulmonary TB):

  • Ascites, lymphadenopathy, bowel wall thickening

• MRI/CT Scan:

  • CNS involvement, spinal TB, organ-specific lesions

3. HEMATOLOGICAL & BIOCHEMICAL INVESTIGATIONS

• Complete Blood Count (CBC):

  • Anemia of chronic disease

  • Elevated ESR

  • Lymphocytosis

• Mantoux Test (Tuberculin skin test):

  • Induration >10mm positive (except in immunocompromised)

• Interferon Gamma Release Assays (IGRAs):

  • Quantiferon-TB Gold – for latent TB diagnosis

• Liver & Renal Function Tests:

  • Before starting anti-TB drugs

4. AYURVEDIC CORRELATION – RAJAYAKSHMA NIDANA & SAMPRAPTI

• Tridosha dushti – Especially Prana Vata, Udana Vata, Sadhaka Pitta, and Avalambaka Kapha

• Dhatu Kshaya – Rasa, Rakta, Mamsa, Meda

• Ojakshaya – Reduced immunity

• Dhatupaka janya jwara – Explains pyrexia due to tissue destruction

सर्वाङ्गेषु च दोषाणां क्षयो दोषविवृद्धये ।
दोषवृद्धिः क्षयो वा च रोगाणामुपलक्षणम् ॥
(Cha. Ni. 1/9)

INTERPRETATION OF FINDINGS

• Positive sputum AFB/CBNAAT confirms TB

• Chest X-ray findings support pulmonary involvement

• Elevated ESR, Mantoux, IGRA – suggest active or latent infection

• Culture and sensitivity help guide drug therapy

• Extrapulmonary investigations help identify TB beyond lungs

DIFFERENTIAL DIAGNOSIS

• Lung cancer

• Chronic bronchitis

• Pneumonia

• Sarcoidosis

• HIV/AIDS-related opportunistic infections

INTEGRATED AYURVEDA-MODERN APPROACH

• Ayurvedic chikitsa like Rasayana therapy, Balya, Dhatuposhaka line of treatment should be implemented as Upashaya therapy.

• Chyavanaprasha, Ashwagandha, Pippali Rasayana are classically indicated.

राजयक्ष्मा नमस्यन्ते सर्वरोगा भयंकराः।
रसयनार्थमायान्ति विशेषात्स च भूषणम्॥
(A.H. Uttara. 39/50)