Video:Miliary tuberculosis
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Description
Miliary tuberculosis 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 to 5 millimeter). Its name comes from a distinctive pattern seen on a chest radiograph 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.[1] Miliary tuberculosis is present in about 2 percent of all reported cases of tuberculosis and accounts for up to 20 percent of all extra-pulmonary tuberculosis cases.[2]
Presentation
Individuals with miliary tuberculosis often experience non-specific signs and symptoms:hypercalcemia, abdominal pain , shortness of breath, fatigue, malaise and swollen glands.[3][4][5]
Complications
In terms of the possible complications we find the following: tubercular empyema, pneumothorax, tubercular pericardial effusion, MODS and ARDS.[6][1]
Cause
Miliary tuberculosis is a form of tuberculosis that is the result of Mycobacterium tuberculosis travelling to extrapulmonary organs.[7] Although it is well understood that the bacteria spread from the pulmonary system to the lymphatic system and eventually the blood stream, the mechanism by which this occurs is not well understood.[8]
Risk factors
The risk factors for contracting miliary tuberculosis are being in direct contact with a person who has it, living in unsanitary conditions, and poor nutrition. In the U.S., risk factors for contracting the disease include homelessness and HIV/AIDS.[9]
Mechanism
One proposed mechanism is that tuberculous infection in the lungs results in erosion of the epithelial layer of alveolar cells and the spread of infection into a pulmonary vein.[8][10] Once the bacteria reach the left side of the heart and enter the systemic circulation, they may multiply and infect extrapulmonary organs.[10] Once infected, the cell-mediated immune response is activated. The infected sites become surrounded by macrophages, which form granuloma, giving the typical appearance of miliary tuberculosis.[11]
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Diagnosis 1
Testing for miliary tuberculosis is conducted in a similar manner as for other forms of tuberculosis, although a number of tests must be conducted on a patient to confirm diagnosis.[3] Tests include chest x-ray, sputum culture, bronchoscopy, CT/MRI, blood cultures, and fundoscopy.[9]
Diagnosis 2
Miliary TB often presents with low bacterial loads and atypical symptoms making conventional diagnostics like smear microscopy or culture less effective.[6]As to advances we find that around the beginning of the 2020's Metagenomic next-generation sequencing of cerebrospinal fluid emerged as a powerful diagnostic tool for detecting CNS involvement in miliary tuberculosis, especially in cases where traditional methods like culture or PCR fall short. By sequencing all nucleic acids in a sample without prior assumptions, mNGS can identify Mycobacterium tuberculosis even in low-bacterial-load or atypical presentations.[12][13]
Treatment
The standard treatment recommended by the WHO is with isoniazid and rifampicin for six months, as well as ethambutol and pyrazinamide for the first two months. If there is evidence of meningitis, then treatment is extended to twelve months, the U.S. guidelines recommend nine months' treatment.[14]
Prognosis
If left untreated, miliary tuberculosis is almost always fatal. Although most cases of miliary tuberculosis are treatable, the mortality rate among children with miliary tuberculosis remains 15 to 20 percent . One of the main causes for these high mortality rates includes late detection of disease caused by non-specific symptoms.[7][6]
Epidemiology
As to regions with the highest prevalence of miliary TB are those with a high overall incidence of TB. The WHO has identified several regions with a high burden of TB, these include: WHO South-East Asia region- India, Indonesia, and Bangladesh; the African region- countries in sub-Saharan Africa; the Western Pacific region- China and Philippines.[15][7][16]
History
John Jacob Manget described a form of disseminated tuberculosis in 1700 and expressed its resemblance to numerous millet seeds in size and appearance and coined the term from Latin word miliarius, meaning related to millet seed.[17]
References
- ↑ 1.0 1.1 Miliary Tuberculosis at eMedicine
- ↑ Ray, Sayantan; Talukdar, Arunansu; Kundu, Supratip; Khanra, Dibbendhu; Sonthalia, Nikhil (2013). "Diagnosis and management of miliary tuberculosis: current state and future perspectives". Therapeutics and Clinical Risk Management. 9: 9–26. doi:10.2147/TCRM.S29179. PMC 3544391. PMID 23326198.
- ↑ 3.0 3.1 Sharma, S., Mohan, A., & Sharma, A. (2012). Challenges in the diagnosis & treatment of miliary tuberculosis. Indian J Med Res, 135, 703–730.
- ↑ Soofi, A., Malik, A., Khan, J., & Muzzafer, S. (2004). Severe Hypercalcemia in Tuberculosis. J Pak Med Assoc, 54(4), 213–215.
- ↑ "Miliary Tuberculosis (TB) - Infections - Merck Manual Consumer Version". Merck Manual Consumer Version. Retrieved 3 September 2025.
- ↑ 6.0 6.1 6.2 Vohra, Shekhar; Dhaliwal, Harpal S. (2025). "Miliary Tuberculosis". StatPearls. StatPearls Publishing.
- ↑ 7.0 7.1 7.2 Sharma, S. K., Mohan, A., Sharma, A., & Mitra, D. K. (2005). Miliary Tuberculosis: New Insights Into An Old Disease. The Lancet Infectious Diseases, 5(7), 415–430.
- ↑ 8.0 8.1 Krishnan, N., Robertson, B. D., & Thwaites, G. (2010). The Mechanisms And Consequences Of The Extra-pulmonary Dissemination Of Mycobacterium Tuberculosis. Tuberculosis, 90(6), 361–366.
- ↑ 9.0 9.1 MedlinePlus Encyclopedia: Disseminated tuberculosis
- ↑ 10.0 10.1 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 516–522 ISBN 978-1-4160-2973-1
- ↑ Jumaah, S. (2012). Tuberculosis. Textbook of Clinical Pediatrics, 1, 1053–1059.
- ↑ Wei, Xiaolin; Xie, Min; Wu, Suji; Bao, Yong (31 December 2024). "The clinical features and prognostic factors of miliary tuberculosis in a high tuberculosis burden area". Annals of Medicine. 56 (1) 2356647. doi:10.1080/07853890.2024.2356647. PMC 11164057. PMID 38848041.
- ↑ "Metagenomic Next Generation Sequencing: How Does It Work and Is It Coming to Your Clinical Microbiology Lab?". ASM.org. Archived from the original on 9 August 2025. Retrieved 1 September 2025.
- ↑ American Thoracic Society, CDC, and Infectious Diseases Society of America (June 20, 2003). "Treatment of Tuberculosis". Archived from the original on October 24, 2022. Retrieved January 16, 2023.
{{cite web}}: CS1 maint: multiple names: authors list (link) Archived October 24, 2022, at the Wayback Machine - ↑ "Tuberculosis (TB)". www.who.int. Archived from the original on 30 July 2020. Retrieved 26 August 2025.
- ↑ Sharma, Surendra K.; Mohan, Alladi (10 March 2017). "Miliary Tuberculosis". Microbiology Spectrum. 5 (2): 10.1128/microbiolspec.tnmi7–0013–2016. doi:10.1128/microbiolspec.tnmi7-0013-2016. PMID 28281441. Archived from the original on 21 April 2025. Retrieved 4 September 2025.
- ↑ Manget, JJ (1700). Sepulcretum size anatomia practica. Vol. 1 (Observatio XLVII (3 vols) ed.). London: Cramer and Perrachon.