Retrospective survey of the management of miliary tuberculosis in South and West Wales, 1976-8.

Monie, R. D. H.; Hunter, A M; Rocchiccioli, K. M. S.; White, Jonathan; Campbell, I. A.; Kilpatrick, G. S.

doi:10.1136/thx.38.5.369

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…However, since the 1980s a changing epidemiological trend has been observed and miliary TB is increasingly being recognized in adults also. Two peaks are evident, one involving adolescents, young adults and another later in life among elderly individuals [2], [3], [4], [5], [14], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50]. This epidemiological change has been thought to be due to global pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), increasing occurrence of organ transplantation, use of immunosuppressive drugs including anti-TNF-α, chronic hemodialysis program, among others.…”

Section: Epidemiologymentioning

confidence: 99%

“…In pediatric as well as adult series [2], [3], [4], [5], [14], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], male gender seems to be more frequently affected by miliary TB. In some adult series on miliary TB [14], [22], [34], [39] a female preponderance has been documented.…”

Section: Epidemiologymentioning

confidence: 99%

“…In children with miliary TB, chills and night sweats, hemoptysis, productive cough are less common; peripheral lymphadenopathy and hepatosplenomegaly are more frequent compared with adults. TBM is more frequently seen in children with miliary TB (20%–40%) [2], [3], [4], [5], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44] compared to adults (15%–30%) [14], [21], [26], [27], [29], [30], [31], [32], [34], [36], [42], [43], [44], [45], [46], [47], [48], [50].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Several factors have been identified as predictors of poor outcome in patients with miliary TB (Table 5) [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [169]. In patients with miliary TB-ARDS [91], acute physiological and chronic health evaluation (APACHE II) score greater than 18; APACHE II score less than or equal to 18 in the presence of hyponatraemia and arterial oxygen tension (PaO 2 ) to fraction of inspired oxygen (FIO 2 ) ratio less than or equal to 108.5 have been identified to be predictors of death.…”

Section: Predictors Of Poor Outcomementioning

confidence: 99%

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Miliary tuberculosis: A new look at an old foe

Sharma

Mohan

Sharma

2016

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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Miliary tuberculosis (TB), is a fatal form of disseminated TB characterized by tiny tubercles evident on gross pathology similar to innumerable millet seeds in size and appearance. Global HIV/AIDS pandemic and increasing use of immunosuppressive drugs have altered the epidemiology of miliary TB. Keeping in mind its protean manifestations, clinicians should have a low threshold for suspecting miliary TB. Careful physical examination should focus on identifying organ system involvement early, particularly TB meningitis, as this has therapeutic significance. Fundus examination for detecting choroid tubercles can help in early diagnosis as their presence is pathognomonic of miliary TB. Imaging modalities help in recognizing the miliary pattern, define the extent of organ system involvement and facilitate image guided fine-needle aspiration cytology or biopsy from various organ sites. Sputum or BAL fluid examination, pleural, pericardial, peritoneal fluid and cerebrospinal fluid studies, fine needle aspiration cytology or biopsy of the lymph nodes, needle biopsy of the liver, bone marrow aspiration and biopsy, testing of body fluids must be carried out. GeneXpert MTB/RIF, line probe assay, mycobacterial culture and drug-susceptibility testing must be carried out as appropriate and feasible. Treatment of miliary TB should be started at the earliest as this can be life saving. Response to first-line anti-TB drugs is good. Screening and monitoring for complications like acute respiratory distress syndrome (ARDS), adverse drug reactions like drug-induced liver injury, drug-drug interactions, especially in patients co-infected with HIV/AIDS, are warranted. Sparse data are available from randomized controlled trials regarding optimum regimen and duration of anti-TB treatment.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Predictors Of Poor Outcomementioning

confidence: 99%

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Miliary tuberculosis: A new look at an old foe

Sharma

Mohan

Sharma

2016

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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“…Σε περιοχές με υψηλό επιπολασμό της νόσου η πλειονότητα των περιπτώσεων εμφανίζεται λίγο μετά την αρχική μόλυνση ενώ σε περιοχές με χαμηλό επιπολασμό οι περισσότερες περιπτώσεις εμφανίζονται σε ηλικιωμένους αποτελώντας επανενεργοποίηση παλιάς λοίμωξης. Τα συμπτώματα είναι ύπουλα στην αρχή και περιλαμβάνουν ανορεξία, κόπωση, πυρετό και απώλεια βάρους[133]. Εκτός από τα παραπάνω γενικά συμπτώματα είναι δυνατόν να παρατηρηθούν κεφαλαλγία, βήχας, δύσπνοια και αιμόπτυση.…”

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