Primary disease may cause no or mild signs and symptoms (fever and occasional pleuritic chest pain) in contrast to the prolonged disease course that is common in postprimary or adult-type disease.

• Primary disease is frequently located in the middle and lower lobes. The primary lesion usually heals spontaneously, and a calcified nodule (Ghon focus) remains.
  • - Transient hilar and paratracheal lymphadenopathy is common.
  • - In immunosuppressed pts and children, primary disease may progress rapidly to significant clinical disease, with cavitation, pleural effusions, and hematogenous dissemination (miliary disease).
• Adult-type disease presents initially with nonspecific and insidious signs and symptoms, such as diurnal fever, night sweats, weight loss, anorexia, malaise, and weakness.
  • - As the disease progresses, pts develop cough and purulent sputum production, often with blood streaking. Extensive cavitation may develop, with occasional massive hemoptysis following erosion of a vessel located in the wall of a cavity.
  • - Disease is usually localized to the apical and posterior segments of the upper lobes and the superior segments of the lower lobes.