Miliary tuberculosis
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| Miliary tuberculosis Classification and external resources | |
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| Miliary tuberculosis. Image courtesy of RadsWiki | |
| ICD-10 | A19. |
| ICD-9 | 018 |
| eMedicine | med/1476 |
| MeSH | D014391 |
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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.[1]
Differential Diagnosis of Miliary Pattern on chest X-ray
- Miliary tuberculosis
- Varicella pneumonia
- Acute hypersensitivity pneumonitis
- Fungal pneumonia
- Thyroid cancer metastases
- Renal cell carcinoma metastases
Etiology
Miliary tuberculosis is a form of tuberculous infection in the lung that is the result of erosion of the infection into a pulmonary vein[2]. Once the bacteria reach the left side of the heart and enter the systemic circulation, the result may be to seed organs such as the liver and spleen with said infection. Alternately the bacteria may enter the lymph node(s), drain into a systemic vein and eventually reach the right side of the heart[2]. From the right side of the heart, the bacteria may seed - or re-seed as the case may be - the lungs, causing the eponymous "miliary" appearance.
Signs and 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.[1]
Diagnostic Findings
Treatment
Miliary TB is a serious condition; untreated miliary TB is almost always fatal. About 25% of patients with miliary TB also have tuberculous meningitis. 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 US guidelines recommend nine months' treatment.
References
- ↑ 1.0 1.1 Lessnau, Klaus-Dieter, "Miliary Tuberculosis", http://www.emedicine.com/med/topic1476.htm, October 3, 2006.
- ↑ 2.0 2.1 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
WikiDoc Research Resources for Miliary tuberculosis | |
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| Articles on Miliary tuberculosis | Most recent articles on Miliary tuberculosis • Most cited articles on Miliary tuberculosis • Review articles on Miliary tuberculosis • Articles on Miliary tuberculosis in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Miliary tuberculosis | Powerpoint slides on Miliary tuberculosis • Images of Miliary tuberculosis • Photos of Miliary tuberculosis • Podcasts & MP3s on Miliary tuberculosis • Videos on Miliary tuberculosis |
| Evidence Based Medicine Regarding Miliary tuberculosis | Cochrane Collaboration on Miliary tuberculosis • Bandolier on Miliary tuberculosis • TRIP on Miliary tuberculosis |
| Cost Effectiveness of Miliary tuberculosis | Cost Effectiveness of Miliary tuberculosis |
| Clinical Trials Involving Miliary tuberculosis | Ongoing Trials on Miliary tuberculosis at Clinical Trials.gov • Trial results on Miliary tuberculosis • Clinical Trials on Miliary tuberculosis at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Miliary tuberculosis | US National Guidelines Clearinghouse on Miliary tuberculosis • NICE Guidance on Miliary tuberculosis • NHS PRODIGY Guidance • FDA on Miliary tuberculosis • CDC on Miliary tuberculosis |
| Textbook Information on Miliary tuberculosis | Books and Textbook Information on Miliary tuberculosis |
| Pharmacology Resources on Miliary tuberculosis | Dosing of Miliary tuberculosis • Drug interactions with Miliary tuberculosis • Side effects of Miliary tuberculosis • Allergic reactions to Miliary tuberculosis • Overdose information on Miliary tuberculosis • Carcinogenicity information on Miliary tuberculosis • Miliary tuberculosis in pregnancy • Pharmacokinetics of Miliary tuberculosis • |
| Genetics, Pharmacogenomics, and Proteinomics of Miliary tuberculosis | Genetics of Miliary tuberculosis • Pharmacogenomics of Miliary tuberculosis • Proteomics of Miliary tuberculosis |
| Newstories on Miliary tuberculosis | Miliary tuberculosis in the news • Be alerted to news on Miliary tuberculosis • News trends on Miliary tuberculosis |
| Commentary on Miliary tuberculosis | Blogs on Miliary tuberculosis |
| Patient Resources on Miliary tuberculosis | Patient resources on Miliary tuberculosis • Discussion groups on Miliary tuberculosis • Patient Handouts on Miliary tuberculosis • Directions to Hospitals Treating Miliary tuberculosis • Risk calculators and risk factors for Miliary tuberculosis |
| Healthcare Provider Resources on Miliary tuberculosis | Symptoms of Miliary tuberculosis • Causes & Risk Factors for Miliary tuberculosis • Diagnostic studies for Miliary tuberculosis • Treatment of Miliary tuberculosis |
| Continuing Medical Education (CME) Programs on Miliary tuberculosis | CME Programs on Miliary tuberculosis |
| International Resources on Miliary tuberculosis | Miliary tuberculosis en Espanol • Miliary tuberculosis en Francais |
| Business Resources on Miliary tuberculosis | Miliary tuberculosis in the Marketplace • Patents on Miliary tuberculosis |
| Informatics Resources on Miliary tuberculosis | List of terms related to Miliary tuberculosis |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
