Miliaire tuberculeuse : à propos de 49 cas

Touré, N.O.; Cissé, M.F.; Kane, Y. Dia; Diatta, A.; Bakioui, B. Bouker; Ndiaye, Emilia; Thiam, K.; Hane, A.A.

doi:10.1016/j.rmr.2011.02.005

Cited by 8 publications

(20 citation statements)

References 7 publications

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“…The mortality rate in our cohort compares favourably to previously reported rates of 10-30% from the developing world and 7.1%-21% from the developed world [2, 4–6]. Critical care intervention and mechanical ventilation, which was required in 15% of our cohort, are likely to be responsible for the low mortality we report as these patients would almost certainly have died if these facilities were not available.…”

Section: Discussionsupporting

confidence: 77%

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Complications of miliary tuberculosis: low mortality and predictive biomarkers from a UK cohort

et al. 2017

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BackgroundUntreated, miliary tuberculosis (TB) has a mortality approaching 100%. As it is uncommon there is little specific data to guide its management. We report detailed data from a UK cohort of patients with miliary tuberculosis and the associations and predictive ability of admission blood tests with clinical outcomes.MethodsRoutinely collected demographic, clinical, blood, imaging, histopathological and microbiological data were assessed for all patients with miliary TB identified from the London TB register from 2008 to 2012 from Northwest London Hospitals NHS Trust. Multivariable logistic regression was used to assess factors independently associated with the need for critical care intervention. Receiver operator characteristics (ROC) were calculated to assess the discriminatory ability of admission blood tests to predict clinical outcomes.ResultsFifty-two patients were identified with miliary tuberculosis, of whom 29% had confirmed central nervous system (CNS) involvement. Magnetic resonance imaging (MRI) was more sensitive than computed tomography (CT) or lumbar puncture for detecting CNS disease. Severe complications were frequent, with 15% requiring critical care intervention with mechanical ventilation. This was independently associated with admission hyponatraemia and elevated alanine aminotransferase (ALT). Having an admission sodium ≥125 mmol/L and an ALT <180 IU/L had 82% sensitivity and 100% specificity for predicting a favourable outcome with an area under the ROC curve (AUC) of 0.91. Despite the frequency of severe complications, one-year mortality was low at 2%.ConclusionsAlthough severe complications of miliary tuberculosis were frequent, mortality was low with timely access to critical care intervention, anti-tuberculous therapy and possibly corticosteroid use. Clinical outcomes could accurately be predicted using routinely collected biochemistry data.

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Section: Discussionsupporting

confidence: 77%

“…Clinical presentations are protean and vary from vague constitutional upset in ambulatory patients to abrupt multi-organ failure [2]. Untreated, miliary TB has a mortality approaching 100% [3], reducing to 7.1-30% with treatment [2, 4–6]. …”

Section: Introductionmentioning

confidence: 99%

Complications of miliary tuberculosis: low mortality and predictive biomarkers from a UK cohort

et al. 2017

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“…The proportion of miliary TB in our study is lower than that observed in other studies carried out in Africa, notably in other countries in the region, including Tunisia [7], Morocco [6], Mali [4], and Senegal [5]. The male:female sex ratio was higher in our study than that observed in other African countries [5], [6], [8]. In our study, the most affected age group was 21–40 years old.…”

Section: Discussioncontrasting

confidence: 83%

“…Miliary TB is a potentially fatal form of TB that results from massive lymphohematogenous dissemination of Mycobacterium tuberculosis [1], [2], [3]. The incidence of miliary TB in relation to all forms of TB is between 0.15% and 10%, depending on the studies conducted by different authors [1], [4], [5]. Its mortality rate has been reported to lie between 13% and 25%, and even up to 65% in patients requiring mechanical ventilation [3], [6].…”

Section: Introductionmentioning

confidence: 99%

Miliary tuberculosis and acute respiratory distress syndrome

Boushab

Basco

2019

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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BackgroundMiliary tuberculosis is a serious and uncommon form of tuberculosis due to hematogenous dissemination of Mycobacterium tuberculosis.ObjectiveThis study aimed to describe the epidemiological and clinical features of miliary tuberculosis.Patients and MethodsData were collected from clinical files between August 2016 and July 2018.ResultsIn 2 years, 24 cases were recorded, representing a proportional morbidity of 13%. Among them, 71% were smokers and 38% had diabetes. The presence of a BCG vaccination scar was observed in 2 patients (8%). Human immunodeficiency virus (HIV) serology was positive in 4 cases (17%). The symptomatology was dominated by: fever (100%), cough (83%), and chest pain (79%). Radiological images with micronodular opacities were the most common (54%), followed by macronodular densities (33%), and reticulonodular densities (13%). The evolution was favorable in 77%, with no patient lost to follow-up, but 7/24 (29%) died, either before the initiation of therapy (n = 2) or during therapy (n = 5).ConclusionMiliary tuberculosis is an acute and severe form of life-threatening tuberculosis. It requires a prompt and accurate diagnosis and treatment. An improved accessibility to early diagnosis and treatment and prevention of TB infection should reduce its prevalence.

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“…Miliary nodular pattern of disease has distinct radiologic features characterized by diffuse, bilateral infiltration of the lungs by tiny, typically 1–4 mm in size, nodules likened to millet seeds [24]. This finding is seen in numerous infectious and inflammatory etiologies, including tuberculosis, histoplasmosis, silicosis, and sarcoidosis [25,26,27,28,29,30]. Miliary nodular patterns have also been in the setting of metastatic disease, most notably with primary thyroid cancer, renal cell carcinoma, and melanoma [24,25].…”

Section: Discussionmentioning

confidence: 99%

Diffuse Lung Metastases in EGFR-Mutant Non-Small Cell Lung Cancer

Digumarthy

Mendoza

Padole

et al. 2019

Cancers

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Diffuse lung metastases have been reported in non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. The purpose of our study was to compare the incidence of diffuse lung metastases in EGFR-mutant NSCLC and EGFR-wild type NSCLC and to assess other imaging features that may be associated with diffuse lung metastases in EGFR-mutant NSCLC. Two radiologists retrospectively reviewed pre-treatment imaging of metastatic NSCLC cases with known EGFR mutation status. We assessed the imaging features of the primary tumor and patterns of metastases. The cohort consisted of 217 patients (117 EGFR-mutant, 100 EGFR wild-type). Diffuse lung metastasis was significantly more common in EGFR-mutant NSCLC compared with wild-type (18% vs. 3%, p < 0.01). Among the EGFR-mutant group, diffuse lung metastases were inversely correlated with the presence of a nodule greater than 6 mm other than the primary lung lesion (OR: 0.13, 95% CI: 0.04–0.41, p < 0.01). EGFR mutations in NSCLC are associated with increased frequency of diffuse lung metastases. The presence of diffuse lung metastases in EGFR-mutant NSCLC is also associated with a decreased presence of other larger discrete lung metastases. EGFR mutations in NSCLC should be suspected in the setting of a dominant primary lung mass associated with diffuse lung metastases.

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Miliaire tuberculeuse : à propos de 49 cas

Cited by 8 publications

References 7 publications

Complications of miliary tuberculosis: low mortality and predictive biomarkers from a UK cohort

Complications of miliary tuberculosis: low mortality and predictive biomarkers from a UK cohort

Miliary tuberculosis and acute respiratory distress syndrome

Diffuse Lung Metastases in EGFR-Mutant Non-Small Cell Lung Cancer

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