Clinical Tuberculosis: Presentation and Diagnostic Approach

Tuberculosis (TB) in adults can present in multiple ways. The lung is the most common site of disease, with cough, hemoptysis, weight loss, and night sweats as the most frequent symptoms. Extrapulmonary involvement, which may present many years after exposure, can affect virtually any organ. Microbiological sampling is key to confirming the diagnosis, but invasive procedures may be necessary to obtain adequate samples. Molecular diagnostics have become a cornerstone of clinical practice, enabling rapid species identification and detection of drug resistance. In immunocompromising conditions, like human immunodeficiency virus (HIV) infection, TB presentation is often atypical and requires a high index of clinical suspicion and may trigger paradoxical inflammatory reactions during otherwise effective treatment. Zoonotic TB, caused predominantly by Mycobacterium bovis, and complications of Bacillus Calmette-Guérin (BCG) therapy are increasingly recognized clinical entities. Following successful treatment, a significant proportion of TB survivors develop post-TB disease. Early diagnosis, multidisciplinary management, and sustained clinical awareness remain essential to reducing the global burden of this disease.