Tuberculosis

I thought I knew about tuberculosis. It was a lung disease which made you cough up blood and then die, like Nicole Kidmann's character in Moulin Rouge.

Then on Infectious Diseases rotation, I heard about an old man who'd gone for elective TURP and the next day started complaining of shortness of breath and shoulder pain. He'd had TB as a young man in Germany and it had lain dormant IN HIS PROSTATE until the TURP, when it had seeded through his bloodstream to his lungs and shoulder.

Here in Zambia there is TB everywhere, especially in HIV patients. It occurs in extrapulmonary sites (haven't seen a TB prostatitis yet) in 10% of non-HIV patients, and 70% of HIV-infected patients.

We had a lady with TB adenitis - massively swollen cervical lymph nodes due to TB infection. They'd started draining pus so she'd had someone open them up with a knife. Of course they'd become infected so she came in with open, purulent sores on her neck. More swellings appeared, so she was taken to theatre for debridement and drainage - pretty much the same thing she'd done at home, just with a CLEAN knife.

Another lady came in with a huge, swollen right leg and pus draining from a slmall ulcer near her knee. The joint was infected with TB, so instead of being hot it was cool, although it was very puffy and the joint was essentially destroyed by the infection. Her best outcome would be surgical fusion of the knee after the infection had cleared up.

There are patients with classic TB on their chest X-rays. They come in very sick, but their prognosis is usually very good if they complete their course of antibiotics (which goes for months). Good to know.