Pulmonary Tuberculosis: Symptoms, Causes, Treatment

If you’ve ever watched an old movie where someone dramatically coughs into a lace handkerchief, you’ve already met
tuberculosis. Thankfully, we’ve upgraded from lace to modern antibiotics, but pulmonary tuberculosis (TB) is
still very real and very serious today. It remains one of the top infectious killers worldwide, even though it’s both
preventable and curable when caught early and treated correctly.

In this guide, we’ll unpack what pulmonary TB is, how it behaves, what symptoms to watch for, how doctors diagnose it,
and the treatments that can actually kick it out of your lungs. We’ll also talk prevention, complications, and what it’s
really like to live through treatment. Expect plain English, a bit of humor, and zero handkerchief glamorizing.

What is pulmonary tuberculosis?

Pulmonary tuberculosis is a contagious infection of the lungs caused by a slow-growing bacterium called
Mycobacterium tuberculosis. While TB can affect almost any part of the body (like lymph nodes, spine, kidneys,
or brain), “pulmonary” specifically means the lungs are involved.

When a person with active pulmonary TB coughs, sneezes, talks, or even sings at full Beyoncé volume, tiny droplets
containing TB bacteria can float into the air. Another person can inhale those droplets, and the bacteria may settle in
their lungs. Not everyone who gets infected develops disease, though – and that’s where the idea of
latent vs. active TB comes in.

Latent TB infection: The bacteria are in your body, but your immune system is keeping them under
control. You have no symptoms, you don’t feel sick, and you can’t spread TB to others. However, the bacteria are not
gone; they’re basically on “pause.”
Active TB disease: The bacteria are awake, multiplying, and causing damage. This is when you develop
symptoms and can spread TB to others if the lungs or throat are involved.

Pulmonary TB refers to active TB disease in the lungs. This is the classic form that most people think of when they hear
“tuberculosis.”

Symptoms of pulmonary tuberculosis

Symptoms of pulmonary TB can start subtly – the kind of “I’m just a little run-down” feeling that’s easy to ignore. Over
time, they usually become more noticeable and persistent.

Common lung-related symptoms

Persistent cough lasting 3 weeks or longer (a major red flag)
Coughing up sputum (mucus) and sometimes blood
Chest pain, especially when breathing deeply, laughing, or coughing
Shortness of breath or feeling winded more easily than usual

That “I can’t shake this cough” situation, especially if it lasts more than a few weeks, is one of the hallmark signs of
pulmonary TB.

General or whole-body symptoms

TB doesn’t just bother your lungs – it can make your entire body feel off. People with pulmonary TB often report:

Fever that may be low-grade and come and go
Night sweats (the kind where you wake up with damp clothes or sheets)
Unexplained weight loss
Loss of appetite
Fatigue and weakness that doesn’t match your activity level
Chills or feeling cold even when others don’t

Taken alone, these symptoms can be confused with flu, a viral infection, or just being overworked. That’s why the
combination of lingering cough + weight loss + night sweats + fatigue should definitely trigger a
conversation with a healthcare professional.

Symptoms in children and older adults

In children, symptoms may be less obvious. They may just seem tired, irritable, or not growing as expected. Older adults
may have vague symptoms such as fatigue and poor appetite without a dramatic cough. Because TB can masquerade as
“getting old” or “a stubborn cold,” it’s important to think about risk factors and exposure history as well.

Causes and how pulmonary TB spreads

TB is caused by Mycobacterium tuberculosis, a bacterium with a thick waxy cell wall that makes it tough, durable,
and annoyingly hard to kill without proper treatment. Here’s how it actually spreads and takes hold:

Airborne transmission

When someone with active pulmonary TB coughs or sneezes, they release respiratory droplets that contain TB bacteria.
These droplets can remain suspended in the air for a while, especially in enclosed, poorly ventilated spaces.

You usually need prolonged, close contact to get infected (this is not a “walk past them once” situation).
TB is not spread by shaking hands, sharing a toilet seat, or touching surfaces.
It’s also not spread through food or water.

From infection to disease

After inhaling the bacteria, your immune system may:

Successfully control them (leading to latent TB, with no symptoms), or
Fail to contain them, allowing the bacteria to multiply and cause active TB disease.

Active disease can happen soon after infection or years later, especially if your immune system becomes weakened.

Risk factors for pulmonary TB

Anyone can get TB, but certain factors increase your risk of infection or progression to active disease:

Close contact with someone who has active pulmonary TB
Living or working in crowded or high-risk settings (e.g., shelters, prisons, long-term care facilities)
Having HIV or other conditions that weaken the immune system
Diabetes, chronic kidney disease, or certain cancers
Undernutrition or low body weight
Smoking or heavy alcohol use
Recent immigration from, or travel to, regions where TB is more common

How pulmonary tuberculosis is diagnosed

Diagnosing TB is a bit like detective work: no single test does it all, and doctors use several pieces of information
to confirm what’s going on.

Medical history and physical exam

Your clinician will ask about your symptoms, how long they’ve been going on, and any TB exposure or risk factors. They’ll
listen to your lungs, check for lymph node enlargement, and look for signs of weight loss or other systemic illness.

TB infection tests

TB skin test (Mantoux test): A small amount of fluid is injected under the skin of your forearm. After
48–72 hours, a healthcare worker checks for a raised bump, which may suggest TB infection.
TB blood tests (IGRAs): These measure how your immune system reacts to TB bacteria in a lab. They’re
often preferred in people who had a BCG vaccine as children.

A positive skin or blood test means TB bacteria are present, but it does not prove active disease.
That’s where imaging and lab tests come in.

Imaging and sputum tests

Chest X-ray: Can show cavities, infiltrates, or other lung changes suggestive of TB. It can’t
definitively confirm TB, but it raises or lowers suspicion.
Sputum smear and culture: You cough up mucus from deep in your lungs. Lab tests look for TB bacteria
under a microscope and attempt to grow them in culture. Culture is the “gold standard” but can take weeks.
Molecular tests: Rapid tests can detect TB DNA and sometimes identify drug resistance within hours
rather than weeks.

Diagnosis is based on a combination of these findings: suggestive symptoms, chest imaging, and lab confirmation from
sputum or other samples.

Treatment options for pulmonary tuberculosis

The good news: pulmonary TB is usually curable with the right antibiotics taken for the full prescribed
course. The less-good news: treatment is not a quick “5 days and you’re done” type of situation. TB therapy takes months.

Standard treatment for drug-susceptible TB

Most people with drug-susceptible pulmonary TB are treated with a combination of antibiotics over at least
4–6 months. The standard regimen usually includes several drugs taken together to ensure all TB bacteria
are killed and to prevent resistance.

Treatment typically involves:

Intensive phase: Several drugs for the first 2 months to quickly reduce the number of bacteria.
Continuation phase: Fewer drugs for the remaining months to clear out the “stubborn” survivors.

Your healthcare team will choose the exact regimen based on guidelines, your medical history, possible drug interactions,
and local resistance patterns.

Drug-resistant TB

Some TB bacteria learn to outsmart standard medications, leading to drug-resistant TB. This can include:

Multidrug-resistant TB (MDR-TB): Resistant to at least isoniazid and rifampin, two of the main first-line drugs.
Extensively drug-resistant TB (XDR-TB): Resistant to even more drugs, making treatment more complex.

Drug-resistant TB treatment often:

Lasts longer (often 9–18 months or more)
Uses second-line medications that may cause more side effects
Requires close monitoring and sometimes specialized centers

This is why finishing your medications exactly as prescribed is so crucial. Stopping early or skipping doses gives TB
bacteria a chance to “train” themselves to resist the drugs.

Monitoring and side effects

TB medications are powerful and can cause side effects, such as:

Upset stomach or nausea
Liver issues (jaundice, dark urine, abdominal pain)
Changes in vision or color perception with certain drugs
Numbness or tingling in hands or feet

You’ll usually have regular visits and lab tests to monitor your liver, kidneys, and overall response. Never stop your
meds on your own – instead, report side effects promptly so your team can adjust your regimen safely.

Prevention: How to lower the risk of pulmonary TB

TB prevention isn’t just about one vaccine or one mask – it’s a combination of strategies designed to reduce both
infection and progression to disease.

Preventing spread from people with active TB

Early diagnosis and starting treatment quickly
Wearing a mask in the early phase of treatment, especially in shared indoor spaces
Improving ventilation (open windows, fans, air filtration) in homes and workplaces
Encouraging close contacts to get tested for TB infection or disease

Once someone with pulmonary TB has been on effective treatment for a period of time (often a few weeks, depending on
medical advice), they usually become much less contagious.

Latent TB treatment

Treating latent TB infection in people at higher risk (such as those with HIV or who’ve recently had
close contact with active TB cases) greatly reduces the chance of developing active disease later. This is a key
strategy in public health efforts to “end TB.”

Vaccination

In many countries, babies receive the BCG vaccine, which provides some protection against severe forms
of TB in childhood. However, its effect on adult pulmonary TB is limited, and it’s not routinely used in low-incidence
countries like the United States. Research is ongoing to develop more effective TB vaccines.

Possible complications of pulmonary TB

Untreated or severe pulmonary TB can cause lasting damage, including:

Permanent lung scarring and reduced lung function
Bronchiectasis (damaged, widened airways that trap mucus and cause repeated infections)
Respiratory failure in severe or advanced cases
Spread of TB to other organs (extrapulmonary TB), such as the spine, brain, or kidneys

The most serious complication, of course, is death. The goal of early diagnosis and full treatment is to prevent both
complications and transmission to others.

When to see a doctor

You should seek medical attention promptly if you have:

A cough lasting 3 weeks or longer
Coughing up blood or blood-streaked sputum
Unexplained weight loss, fevers, or night sweats
Close contact with someone diagnosed with TB, especially if you start feeling unwell

If you’re at higher risk (due to medical conditions, work environment, or living situation), your healthcare professional
may recommend TB testing even if you feel fine. That’s an opportunity to detect and treat latent TB before it becomes
a bigger problem.

Living with pulmonary TB: Practical tips

Getting a TB diagnosis can be emotionally heavy. But treatment is your roadmap back to health, and there are practical
ways to make the journey smoother.

Stick to your medication schedule. Use phone reminders, pill boxes, or apps so you don’t miss doses.
Some programs offer directly observed therapy (DOT), where a healthcare worker helps you stay on track.
Protect others while you’re contagious. Follow masking and isolation guidance, ventilate your living
space, and cover your mouth when coughing.
Support your immune system. Eat balanced meals, hydrate, and rest as much as your body needs.
Talk about mental health. Long treatment courses and isolation can trigger anxiety or depression.
Reaching out to friends, family, or a counselor can help.
Keep all follow-up appointments. Your team monitors side effects, checks your progress, and confirms
when you’re no longer infectious.

Think of treatment as a long but very winnable marathon. The finish line is not just feeling better, but knowing the
bacteria are fully cleared to protect your long-term health.

Real-world experiences: What pulmonary TB can feel like

Every person’s journey with pulmonary TB is unique, but there are common threads. The stories below are composites based
on typical experiences shared by patients and clinicians – not any one real person – designed to give a realistic sense
of what living through TB can look like.

“I thought it was just a stubborn cold”

One office worker in his 30s started with a dry cough that wouldn’t quit. He blamed air-conditioned office air, then
seasonal allergies, then stress. Only when he started losing weight, waking soaked in sweat, and feeling exhausted all
day did he finally see a doctor. A chest X-ray and sputum tests later, he learned the cough he’d been brushing off was
actually pulmonary TB.

The diagnosis was scary – words like “contagious,” “isolation,” and “months of antibiotics” tend to grab your brain’s
attention. But once he started treatment, he noticed something surprising: within a few weeks, his cough eased and his
energy started creeping back. The hardest part wasn’t feeling sick; it was staying disciplined with pills for months
after he felt “normal” again. What kept him going was the reminder that stopping early wasn’t just risky for him – it
could also contribute to drug-resistant TB, which is much harder to treat.

“The isolation was almost worse than the disease”

A college student diagnosed with TB had to temporarily move out of a shared dorm room and attend classes online. Her
friends were supportive but nervous, and she found herself explaining over and over that TB isn’t spread through casual
contact once treatment starts and that she was following all medical advice.

She described the first few weeks on medication as a mix of fatigue, mild nausea, and emotional ups and downs. What
helped most was creating a routine: waking up at the same time, taking her meds with food, doing short walks on days she
felt stronger, and scheduling video calls with friends. By the time her healthcare provider cleared her to return to
campus life, she felt not only physically better, but also more aware of how important public health and early testing
are.

“Living with other health conditions made TB more complicated”

For someone with diabetes, HIV, or another chronic condition, TB can be an unwelcome extra puzzle piece. One middle-aged
patient with diabetes found that TB treatment meant more frequent visits and more careful monitoring of blood sugar and
liver function. There were more pills to manage, more lab results to track, and more conversations about side effects.

But there was also more support: infectious disease specialists, nurses, and case managers worked as a team. They helped
coordinate appointments, adjust medications, and connect the patient with nutrition counseling. The key takeaway from
experiences like this is that TB rarely exists in isolation – it intersects with real lives, real families, and real
challenges. A strong healthcare team and good communication can make that intersection safer.

“What I wish I’d known earlier”

When people look back on their TB journey, they often say they wish they had:

Taken a lingering cough more seriously, especially when paired with fatigue and weight loss
Known that TB is still common worldwide and not just an “old-fashioned” disease
Understood that treatment, while long, is highly effective when followed carefully
Realized how important it is to protect loved ones by getting tested and treated promptly

The experiences of people who’ve been through pulmonary TB highlight two big truths: first, that TB is still a serious,
modern health issue; and second, that with proper diagnosis, treatment, and support, it’s absolutely beatable.

Bottom line

Pulmonary tuberculosis is a lung infection that deserves your full attention, but not your panic. Knowing the
symptoms – especially a long-lasting cough, night sweats, weight loss, and fatigue – along with the
causes and risk factors, makes it easier to recognize when something isn’t right.
Modern tests, combination antibiotic therapy, and public health strategies mean that TB is more treatable than ever.

If you or someone you know has a persistent cough or risk factors for TB, talking to a healthcare professional is the
best next step. Early diagnosis and complete treatment protect not only your own lungs, but the health of your family,
friends, and community.