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Miliary tuberculosis is a condition characterized by subacute or acute generalized tuberculosis infection in the body due to the spread of tuberculosis mycobacteria through the bloodstream. The ailment occurs when tuberculosis bacilli (from some primary or usually post-primary) enter the blood and thus spread mainly in the lungs, meninges of the brain or other internal organs or bones.
Miliary tuberculosis – what is it?
Miliary tuberculosis is a disease that indicates acute or subacute generalized tuberculosis infection in the human body. Miliary tuberculosis usually occurs one year after primary tuberculosis, so it mainly affects children who are very prone to acute tuberculosis, but it is not uncommon in adults. It is a serious disease (the most severe form), often mistaken for typhus. It is characterized by lesions in various organs and develops when mycobacteria are disseminated through the bloodstream, both during primary infection (first exposure to mycobacteria) and during a resumption of an infection acquired in the past. In miliary tuberculosis, nodules often occur in the spleen, meninges, peritoneum, kidneys and bone marrow.
Causes of miliary tuberculosis
Mycobacterium bacteria (over 70 species) are considered to be the cause of miliary tuberculosis. We can find them in air, soil, water and animals. In humans, only a few species of this bacterium pose a particular threat, and their spread takes place, for example, during surgical procedures on the affected organ. The risk of the disease is increased in unvaccinated children, in those who are immunocompromised or who have been taking certain medications that suppress the body’s defenses for a long time.
Symptoms of miliary tuberculosis
In the organs, small tuberculosis foci and numerous lumps the size of millet grains form – that is why this disease is called miliary tuberculosis. The effect of such spreading, e.g. into the lungs, is:
- septic, very serious general condition of the patient,
- dyspnoea,
- sinica,
- cough,
- rapid and shallow breathing,
- apathy, darkness,
- symptoms of poisoning,
- fever,
- systematic weight loss.
Types of miliary tuberculosis
Depending on the symptoms, miliary tuberculosis can be divided into the following forms:
- typhoid fever and intoxication of the body;
- lungs – in addition to general symptoms, respiratory failure occurs;
- meningeal – infectious foci are present in the meninges.
Miliary tuberculosis – diagnostics
If a patient sweats excessively at night, is losing weight for no reason, has no appetite or is weakened, he / she should consult a doctor as soon as possible, preferably an infectious disease specialist.
The basic examination in the diagnosis of miliary tuberculosis is radiological examination, which reveals disseminated and symmetrical lesions with the appearance of small, uniformly sized nodules. These nodules have blurred edges, which radiologists describe in the photos as the phenomenon of a blizzard (in the case of a developed disease). Organs may be normal initially.
The second important research is bacteriological research. Mycobacteria can be found in the liver, bone marrow, sputum, or lungs after a biopsy. Mycobacteria can also be found in the patient’s blood and urine.
Thus, miliary tuberculosis is diagnosed on the basis of the following tests:
- computed tomography of the brain and chest,
- Blood tests,
- Chest X-ray,
- echocardiographic examination,
- examination of internal organs,
- collection of cerebrospinal fluid through the lumbar puncture.
The results of the conducted tests are the basis for making or excluding the diagnosis of miliary tuberculosis. It is impossible to diagnose the disease on the basis of symptoms alone, an individual approach to the patient and the necessary tests are needed.
Treatment of miliary tuberculosis
In the treatment of miliary tuberculosis, intensive, specialist hospital treatment is necessary, which consists in taking appropriate doses of anti-tuberculosis preparations. The patient should also remember about an appropriate lifestyle and rest, and compliance with the doctor’s instructions. Some patients require lung resection, especially if the patient has haemoptysis. Very severe cases of miliary tuberculosis require the removal of part or all of the lung and application of an artificial pneumothorax or drainage.
In the past, hematogenous miliary tuberculosis was fairly common and was usually fatal. Recently, it has been seen much less frequently, and the treatment results are also clearly better. Rarely, hematopoietic dissemination is secretive, chronic, almost asymptomatic.
Miliary tuberculosis – prognosis
In the past, miliary tuberculosis meant almost 100% mortality. Today, mortality can be reduced by 10% with the prompt implementation of appropriate treatment. The highest mortality rate occurs in patients who start therapy too late. Relapse of healed tuberculosis is possible in about 4%, but when the patient is scrupulously adhering to medical recommendations and taking medications, the risk of reinfection is much lower.
Complications
Tuberculosis (especially if left untreated) can cause lung defects or serous pneumonia.
How to prevent miliary tuberculosis?
Prevention of miliary tuberculosis is primarily about avoiding close contact with people who have symptoms of lung disease. You should also remember about a well-balanced diet that will strengthen your immunity. The most important thing is to avoid factors that significantly reduce it, e.g. frequent exposure to cold, lack of physical activity or working in difficult conditions.
In underdeveloped countries, epidemic prevention measures should be implemented.