Miliary tuberculosis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Miliary tuberculosis (or disseminated TB) is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1-5 mm). Its name comes from a distinctive pattern seen on a chest X-ray of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds, thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs including the lungs, liver, and spleen. It is a complication of 1-3% of all TB cases.
Pathophysiology
Tuberculosis (TB) infection can develop after inhaling droplets sprayed into the air from a cough or sneeze by someone infected with the Mycobacterium tuberculosis bacteria. Small areas of infection, called granulomas (granular tumors), develop in the lungs.
Causes
Disseminated TB develops in the small number of infected people whose immune systems do not successfully contain the primary infection. It can occur within weeks of the primary infection. Sometimes, it does not occur until years after you become infected. Chances of having miliary tuberculosis is high if the immune system is weakened due to disease (such as AIDS) or certain medications. Infants and the elderly are also at higher risk.
Diagnosis
Symptoms
A patient with miliary tuberculosis will tend to present with non-specific signs such as low grade fever, cough, and generalized lymphadenopathy. Miliary tuberculosis can also present with hepatomegaly (40% of cases), splenomegaly (15%), pancreatitis (<5%), and multiorgan dysfunction with adrenal insufficiency.
Treatment
Secondary Prevention
TB is a preventable disease, even in those who have been exposed to an infected person. Skin testing for TB is used in high risk populations or in people who may have been exposed to TB, such as health care workers.