Hematogenous Tuberculosis in Children

Abstract

Knowledge of the pathogenesis of primary tuberculous infection in childhood has been increasing by leaps and bounds in the last fifteen years. And with this has come a revolution in the conception of the part that the blood stream plays in the postprimary development of tuberculosis. relation to tuberculosis, in which tubercle bacilli were cultured from the From the

Transcriptional Profiling of Mycobacterium tuberculosis Replicating Ex vivo in Blood from HIV- and HIV+ Subjects

“…Hematogenous dissemination of M. tb occurs during the natural course of establishment of latent infection leading to the systemic seeding of the host organs [1] , [2] , [3] , [4] , [5] , [8] . Hematogenous presence of M. tb is also frequently observed during both primary and reactivation pulmonary and extrapulmonary TB, and in disseminated and miliary TB.…”

“…Studies in animal models have demonstrated hematogenous dissemination of M. tb from the lungs to various organs, including lymph nodes, spleen, liver, pancreas, adrenal, and heart, as well as reseeding of the lung, during primary infection [1] , [2] , [3] . Studies performed in the pre-ATT (anti TB treatment) era demonstrated hematogenous dissemination of M. tb in a majority of pediatric cases of primary TB [4] . Viable M. tb have been demonstrated in lungs, liver, spleen and kidneys of healthy individuals who died of causes unrelated to TB, in a TB endemic setting [5] .…”

Tuberculous meningitis and miliary tuberculosis: the Rich focus revisited

“…They did concede that a small number of meningeal tubercles might be found in such cases, and others confirmed this. 6,11 M. tuberculosis could also be cultured from the cerebrospinal fluid in some of these cases, who did not have TBM. 6 Secondly, they observed '… that the age and character of the miliary tubercles in the viscera in patients dying with miliary tuberculosis and tuberculous meningitis may not correspond at all with the age and character of the meningitis…' and claimed that this argued against a contemporaneous origin of the miliary tuberculosis and TBM.…”

Mycobacterium tuberculosis Dissemination Plays a Critical Role in Pathogenesis

“…Case studies and pathology of human patients throughout medical history indicate that dissemination may in fact be an essential first step in establishing all active tuberculosis infections, even when these infections present as prototypical pulmonary infections. As early as 1935, Dr. Elizabeth Lincoln noted a trend in the literature away from the previous thinking that disseminated tuberculosis was a rare event inevitably leading to catastrophic outcomes such as miliary tuberculosis, but rather a potential intermediate step of infection (Lincoln, 1935).…”