AZERBAIJAN 1
MEDICAL
UNIVERSITY
NAME: ZAKARYA KAMAL SATTOUF
GROUP: 180B
SUBJECT: MILIARY TUBERCULOSIS
DATE; 12/7/2019
INTRODUCTION
Definition 2
History
Risk factors
Types and forms
Pathophysiology of miliary TB
Clinical findings
Diagnosis
Differentiation
Treatment
Complication
prevention
References
DEFINITION
Miliary TB is an a form of disseminated TB 3
or Extra pulmonary TB that is caused by
sudden diffuse dissemination of tubercli
bacili through the bloodstream
( hematogenous spread of TB )
The foci are possible caseous - necrotic
changes. Focal changes develop in the
interstitial tissues
In miliary TB foci formed small ( 1-2 mm )
with productive tissue reaction
Small foci look like millet grains
Miliary Tuberculosis: mainly occurs in
children and young adults but may also
occur in older people and it is insidious in
onset in this older age group
Miliary TB : is can be difficult to diagnose
especially in older age group in which case
it is known as Cryptic Tuberculosis (because
of its insidious onset
HISTORY
Miliary TB got its name in 1700 from John Jacob
Manget based on how it appears on autopsy
findings.
The bodies would have a lot of very small spots
similar to hundreds of tiny seeds about
2 millimeters long scatted in various tissues.
Since a millet seed is about that size,
the condition became known as miliary TB
Small foci like millet seed which is
scatted in various tissues
RISK FACTORS
4
• Age – Child & Elderly
• Immunosuppression
• Cancer
• Transplantation
• HIV
• Malnutrition
• Diabetes
• Silicosis
• End-stage renal disease
TYPES
The miliary TB can be develop in the
1. Miliary pulmonary tuberculosis: occurs when the
organisms draining through the lymphatic and
pulmonary arterioles and enter to the venous blood
and circulate back to the lung
2. Systemic miliary tuberculosis ; occurs when bacteria
disseminate through the systemic arterial system.
THE MAIN CLINICAL FORMS
OF MILIARY TB
SEPSIS
POLMONARY MILIARY TB TYPHOIDAL
MENINGITIC
PATHOPHYSIOLOGY OF
MILIARY TB 5
• Tuberculosis infection in the lungs results in
erosion of the epithelial layer of alveolar cells
and the spread of infection into a pulmonary vein
• Bacteria reach the left side of the heart and
enter the systemic circulation, they may multiply
and infect extra pulmonary organs
• 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
CLINICAL FINDINGS
6
• Patients may not be acutely ill
• Symptoms include
• Weakness and fatigue (90%)
• Fever and weight loss (80%)
• Chills, night sweats are common
• Cough,
• Hemoptysis
• Anorexia
• Hepatomegaly and lymphadenopathy are
common
DIAGNOSIS
• CBC
7
- Leukopenia/leukocytosis
• ESR - elevated in approximately 50% of
patients
• Lumbar puncture - strongly considered
Lymphocytic predominance (70%)
Elevated protein levels (90%)
Low glucose levels (90%)
Acid-fast bacilli (≥40%)
• Cultures for mycobacteria
• PCR
CHEST X-RAY
8
• Typical appearance only in 50% of cases
• Bilateral pleural effusions indicate
dissemination. This may be a useful clue.
• Nodules characteristic of miliary TB may
be better visualized on lateral chest
radiography (especially in the retro cardiac
space).
• Nodules are the size of millet seeds
(1-5mm, mean=2mm)
CT SCAN
9
MILIARY ABDOMINAL
TUBERCULOSIS TYPHUS
• Breathlessness • The typhus begins with
• Cyanosis gradually developing of
• Tachycardia weakness and increase of
• irregular type fever temperature
• absence of dyspeptic • Bradycardia
disturbances leucopenia
leucocytes within the limits of lymphocytosis
norm or leucocytosis up to • Widal’s reaction can be
15 000-18 000 positive just in typhus
lymphopenia
Monocytosis
• Roentgenograms confirm
suspicions on miliary lung
tuberculosis
TREATMENT
10
• Four-drug regimen to start
Isoniazid
Rifampin
Pyrazinamide
Ethambutol or streptomycin
• Treatment may continue for 6-9 months
• 9-12 months with meningeal involvement
COMPLICATIONS
11
• Dissemination via bloodstream to
I. Prostate
II. Seminal vesicles
III. Epididymis
IV. Fallopian tubes
V. Endometrium
VI. Meninges
VII.Lymph nodes
VIII.Liver
IX. Spleen
X. Skeleton
XI. Kidneys
XII.Adrenals
PREVENTION
BCG vaccination
Effective in reducing the incidence of miliary
tuberculosis Not effective in individuals who are
already infected
Should not be administered to
immunosuppressed hosts
Targeted tuberculin testing
Treatment of latent tuberculosis infection
REFERENCES:
12
https://www.slideshare.net/chaudharymahesh/miliary-tuberculos
is-dr-mahesh
http://tuberkulez-forever.com/tuberkulez-likbez/eng
https://
www.slideshare.net/DeepakKumarGupta2/granulomatous-infla
mmation-tuberculosis-syphillis
https://
www.slideshare.net/ghalan/pulmonary-tuberculosis-2941528
https://slideplayer.com/slide/10787857/
https://en.wikipedia.org/wiki/Jean-Jacques_Manget
https://
www.slideshare.net/chaudharymahesh/miliary-tuberculosis-dr-
mahesh
https://www.youtube.com/watch?v=9HUmsnp-nYg
https://www.healthline.com/health/miliary-tuberculosis
