Study of respiratory symptoms among sputum positive

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-,,-' .l
Abdominal pam IS less specific but has been associated with
involvement ofthe peritoneum or partial intestinal obstruction secondary to
lymph node or omental involvement. Dyspnea, when present, may be the
result of underlying lung disease or ofdecreased diffusing capacity 2ry to
extensive interstitial tubercles (Williams et al., 1973). The symptoms are
usually protracted, averaging between 3 and 15 weeks except, in
immunosuppressed patients or those with serious co-existing disease in
whom the onset may be more abrupt (Divinagracia and Harris, 1999).
Physical signs:
The signs most often present on physical examination III elder
include fever, tachycardia, and adventitious sounds on pulmonary
examination. Splenomegaly and lymphodenopathy, although common m
children, frequent findings in adult. Hepatomegaly is common; studies
from Groote shur Hospital in South Africa documented hepatomegaly in
50% to 65% ofpatients, most ofwhom are adults (Maartens et aI., 1990).
Choroidal tubercles are gray, gray-whit, or yellowish lesions usually less
than one quarter the size ofthe optic disc and appearing within 2 mm ofthe
optic nerve. They are usually multiple bilateral, with one to five found in
the choroid of both eyes. Histologically they are similar to other
tuberculous lesions and may be either caseating or non caseating
granuloma (Massaro et aI., 1964).
Cutaneous manifestations of miliary tuberculosis are discrete, dull
erythematous macules and papules that are initially the size ofa pin head.
They may become capped by tiny vesicles that after rupturing, have
papules with a central crust. The lesions are most frequently localized on
thighs, buttocks, genitalia, and extremities. They usually number no more
41