The Big deal about Tb

Tb (Tuberculosis) was just another disease that I'd learnt about in med school in the US. It was a very bad disease with a very long treatment. And if you had it you were probably an immigrant from India or some African country.
I was surprised back in Cameroon when my first HIV/AIDS patient who presented with a lung infection became a topic for discussion amongst my young colleagues and myself. While it was clear to them that Tb was high on the list, I was thinking of PCP, which is also a bad disease but as I came to realize, is less common than Tb. So we never really found out which one of the two my patient was suffering from, which is often the case so we treated for both. 
Several months later, in a teaching hospital, I was exposed to a wider array and diversity of medical conditions. But I still kept bumping into Tb...in its multiple forms: patient has a  chronic cough-Tb; patient has a big belly-Tb, weight loss-Tb, patient has a big heart-Tb too. Tb was everywhere!!! So I learnt that it could be pulmonary ie in the lung (and which everyone knew of) or it could be extra-pulmonary ie outside the lungs. 

A normal chest Xray. Courtesy of WedMD

Chest Xray of pulmonary Tb (look at right upper lung)

And outside the lungs, Tb could affect any organ ranging anywhere from spacing outside the lung (the pleura) right down to even the genitourinaty tract. Yes, there is such a thing as urogenital Tb as well as Tb meningitis, Tb of the bone (Pott's disease-spine), Tuberculous ulcers and abscesses, Tb pleurisy, and the list goes on and on. But what has marked me the most so far is Tb of the lining outside the heart called Tb pericarditis.
I met a young man who looked really sick. While examining him, his heart sounds weren't loud enough so I got an chest x-ray (below). His heart was huge and globular (water-bottle heart), which is characteristic of a heart with fluid in its pericardium, a space surrounding it. In this case, the fluid resulted from the inflammation that Tb was causing in the pericardium (Tb pericarditis). Sometimes, this fluid can accumulate such that it prevents the heart from filling and pumping blood properly. This condition is called cardiac tamponade and is a medical emergency. Fortunately, our patient didn't have that although he did have a lot of fluid around his heart.

Water bottle heart in pleural effusions

My patient had other symptoms such as profuse sweating especially at night-time (night sweats) and weight loss, but he was also suffering from HIV/AIDS. The plan was to start him on Tb meds, a painful 6 month course of multiple antibiotics all in a special cocktail with varying side effects. With good compliance, most people are completely cured, but that's when they are relatively healthy. The picture can be complicated by co-morbidities such as HIV and diabetes; these can and usually worsen the outcome. 
As for me, my journey continues as I unravel more and more Tb mysteries and discoveries. Wish me luck...