Diagnosis and management of miliary tuberculosis: current state and future perspectives

Ray, Sayantan; Talukdar, Arunansu; Kundu, Supratip; Khanra, Dibbendhu; Sonthalia, Nikhil

doi:10.2147/tcrm.s29179

Cited by 70 publications

(92 citation statements)

References 101 publications

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“…Hypercalcemia has been described in 13.4% of the patients with disseminated TB, [2] in our study it was found only in 1/100 (1%) patient. In our series tuberculin skin tests were positive in 42% of the cases, which falls within the range of 20-70% mentioned in the literature [14]. Skin testing is frequently unreliable and of no help in excluding or confirming the disease.…”

Section: Investigations and Proceduressupporting

confidence: 80%

“…Meningitis was found in 23 (23%) of our patients, which falls within the range of 10-30% mentioned in the literature [3,13,14]. Choroidal tubercles are pathognomonic of disseminated TB and offer a valuable clue to the diagnosis [14,15]. In our patients, there was no mention of the frequency of choroidal tubercles since funduscopic examinations were not routinely performed.…”

Section: Clinical Featuressupporting

confidence: 63%

“…To confirm the diagnosis in patients with suspected disseminated TB, selection of appropriate tissue and body-fluid samples, which depends on the extent of organ-system involvement, is needed [6,14]. Detailed history, physical examination and appropriate imaging studies (chest and abdomen contrast-enhanced computed tomography (CT) and Magnetic resonance imaging (MRI)) may help in determining the best approach for such patients.…”

Section: Investigations and Proceduresmentioning

confidence: 99%

“…Diagnostic modalities are useful in identifying miliary lesions at occult extrapulmonary sites. For example, an abdominal CT scan can detect intra-abdominal lymphadenopathy, cold abscesses and lesions in the liver, spleen, mesentery and peritoneum [3,14].…”

Section: Investigations and Proceduresmentioning

confidence: 99%

“…If patient cannot give sputum, endotracheal secretions and gastric lavage can also be used to confirm the diagnosis. Fiberoptic bronchoscopy (FBS), bronchoalveolar lavage (BAL), bronchoscopic aspirate, brushings, washings, and transbronchial biopsy (TBB) are important diagnostic procedures in patients with suspected disseminated TB whose sputum specimens were negative for smear [14]. The combination of the various bronchoscopy samples increased the diagnostic yield to 46-92% [14,16].…”

Section: Investigations and Proceduresmentioning

confidence: 99%

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Disseminated Tuberculosis among Adult Patients Admitted to Hamad General Hospital, Qatar: A Five Year Hospital Based Study

Khan¹,

Dosa²,

Fuad³

et al. 2016

Mycobact Dis

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Objectives: To describe the demographic, clinical features, diagnostic and procedure results, organ involvement and outcomes in patients with disseminated tuberculosis (TB). Patients and methods:This retrospective observational study was conducted at Hamad general hospital in Qatar. It involved all patients 15 years of age or older who were admitted to Hamad general hospital with disseminated TB from January 1, 2006 to December 31, 2010. Results:We enrolled 100 patients. There were 74 (74%) males and the mean age (±SD) of patients was 31.3±12.2. The most common presenting symptom was fever (95%). Fifteen (15%) patients had other underlying medical conditions; the most common being diabetes mellitus 7 (7%), while two patients had human immunodeficiency virus (HIV) infection. The tuberculin skin test was positive in 42 (42%) patients. Sputum and gastric lavage examination were performed in 84 (84%) and 9 (9%) patients respectively while bronchoscopy was performed on 32 (32%) cases.Most patients 94 (94%) completed their treatment in Qatar whereas (3%) left the country before completion. The in-hospital mortality rate was 3% (3 patients). Systemic corticosteroids were prescribed for 36 (36%) cases and 15 patients had complications, the most being tuberculoma 9/23 (39.1%). Drug toxicity was noted in 17 (17%) patients, including hepatitis, optic neuritis and hyperurecemia. Only presence of underlying medical conditions was found to be an independent predictor of mortality.Conclusions: Disseminated TB has a non-specific clinical picture, gives rise to high morbidity and mortality and therefore demands a high index of suspicion to promptly diagnosis and initiate timely treatment.

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Section: Investigations and Proceduressupporting

confidence: 80%

Section: Clinical Featuressupporting

confidence: 63%

Section: Investigations and Proceduresmentioning

confidence: 99%

Section: Investigations and Proceduresmentioning

confidence: 99%

Section: Investigations and Proceduresmentioning

confidence: 99%

See 3 more Smart Citations

Disseminated Tuberculosis among Adult Patients Admitted to Hamad General Hospital, Qatar: A Five Year Hospital Based Study

Khan¹,

Dosa²,

Fuad³

et al. 2016

Mycobact Dis

View full text Add to dashboard Cite

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Miliary tuberculosis in an immune‐competent Bangladeshi man—A case report

Paul

Ahmed

Chakrabortty

et al. 2023

Clinical Case Reports

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Miliary tuberculosis (MTB) is a rare and fatal infectious disease that occurs due to the lympho-hematogenous spread of Mycobacterium tuberculosis bacilli. 1 According to the world health organization (WHO) 2021 reports, the incidence of tuberculosis in Bangladesh and Malaysia is around 221 and 97 per 100,000 people, respectively. It involves commonly the lung but may also affect other systems in the body. In all forms of tuberculosis cases, MTB occurs in 1%-2%, and in extrapulmonary tuberculosis, it is approximately 8%. 2 Clinical features of MTB are nonspecific, such as prolonged pyrexia, night sweats, weight loss, lassitude, anorexia, hepatomegaly, and abdominal pain. When the lungs are, an affected patient presents with cough, dyspnea, and chest pain. Occasionally, patients with miliary tuberculosis can present with "pyrexia of unknown origin" (PUO).Atypical clinical manifestation often delays the diagnosis and may cause a fatal outcome. Therefore, a high index of clinical suspicion is needed to diagnosing of MTB. Chest radiography plays a vital role in the initial detection and final diagnosis of MTB, but miliary mottling is seen in only 50% of cases of miliary tuberculosis. 3 Only one-third of MTB patients are sputum smear-positive. Histological demonstration of granulomatous inflammation in biopsy tissue (e.g., liver, lung, and bone marrow) is usually required to make a prompt diagnosis. 4 The molecular diagnosis of mycobacterium tuberculosis DNA by polymerase chain reaction is helpful, and it is rapid, sensitive, and specific. 5 MTB is more likely to see in an immune-compromised patient due to suppression of their cellular immunity and is rarely affected in an immune-competent patient.Herein, we reported a case of miliary tuberculosis in an immune-competent Bangladeshi man presented with pyrexia of unknown origin and hyponatremia.

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