Predictors and outcomes of disseminated tuberculosis in an intermediate burden setting

A Case Report of Widely Disseminated Tuberculosis in Immunocompetent Adult Male

“…These predisposing factors include impaired cell-mediated immunity as seen in HIV/acquired immune deficiency syndrome patients, increased use of immunosuppressive drugs, diminished ability of the liver to clear bacteria from the bloodstream as seen in advanced liver disease among others, and recent immigration from areas with high rates of TB. 1,2,7 Additionally, they should acknowledge that TB may present atypically in patients with minimal predisposing factors, rendering the need to further investigate abnormal CXR images despite laboratory results inconsistent with TB. EPs should also have a low threshold to order an AFB culture for the first CSF analysis with any suspicion for TB in a patient.…”

“…Although radiographs can be beneficial for TB diagnosis, approximately half of disseminated TB cases do not present with this typical lung pattern, rendering alternate means of imaging such as high-resolution CT or MRI. 1,4,7 Despite robust therapeutic options, mortality rates are high as early diagnosis is hard to obtain because there is a lack of a gold standard for diagnosis. 5 Currently, diagnosis requires presence of diffuse miliary infiltrate on CXR or high-resolution CT.…”

“…1,4 Although rare, predisposing factors to disseminated TB include elderly patients, individuals with childhood infections, human immunodeficiency virus (HIV), alcohol abuse, diabetes, chronic liver or kidney Volume IV, NO failure, organ transplant, pharmacological immunosuppressants, pregnancy, and symptoms lasting longer than 12 weeks. 1,3,7 TB can disseminate to any organ system of the body, 22% of which disseminate to the central nervous system (CNS) including meningitis, cerebral tuberculoma, tuberculoma abscess, and thoracic transverse myelopathy. 1,6 TB meningitis accounts for 10-30% of CNS disseminations.…”

“…1 Because of disseminated TB's nonspecific clinical presentation such as weight loss, night sweats, cough, fever, anorexia, and weakness, it is increasingly difficult to diagnose despite the urgent need. [4][5]7 Because TB with dissemination to the CNS is rarely seen in the emergency department (ED), the current case stands to acknowledge the importance of early identification in the ED leading to optimal management and treatment. We report the case of an immunocompetent adult male presenting to the ED with severe headaches due to disseminated TB to the brain, spinal cord, meninges, muscle, joint, and bone.…”

“… 1 , 4 Although rare, predisposing factors to disseminated TB include elderly patients, individuals with childhood infections, human immunodeficiency virus (HIV), alcohol abuse, diabetes, chronic liver or kidney failure, organ transplant, pharmacological immunosuppressants, pregnancy, and symptoms lasting longer than 12 weeks. 1 , 3 , 7 …”