Definition

What is miliary tuberculosis?

Miliary tuberculosis 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 radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term “miliary” tuberculosis. Miliary tuberculosis may infect any number of organs, including the lungs, liver, and spleen.

How common is miliary tuberculosis?

Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and accounts for up to 20% of all extra-pulmonary tuberculosis cases.

However, it can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of miliary tuberculosis?

Patients with miliary tuberculosis often experience non-specific signs, such as coughing and enlarged lymph nodes.

Miliary tuberculosis can also present with:

  • Enlarged liver (40%)
  • Enlarged spleen (15%)
  • Inflammation of the pancreas (<5%)
  • Multiple organ dysfunction with adrenal insufficiency (adrenal glands do not produce enough steroid hormones to regulate organ function).
  • Miliary tuberculosis may also present with unilateral or bilateral pneumothorax rarely.
  • Stool may also be diarrheal in nature and appearance.

Other symptoms include fever, hypercalcemia, chorodial tubercles and cutaneous lesions:

  • Firstly, many patients can experience a fever lasting several weeks with daily spikes in morning temperatures.
  • Secondly, hypercalcemia prevails in 16 to 51% of tuberculosis cases. It is thought that hypercalcemia occurs as a response to increased macrophage activity in the body. Such that, 1.25 dihydroxycholecalciferol (also referred to as calcitriol) improves the ability of macrophages to kill bacteria. However, higher levels of calcitriol lead to higher calcium levels, and then hypercalcemia in some cases.
  • Thirdly, chorodial tubercules, pale lesions on the optic nerve, typically indicate miliary tuberculosis in children. These lesions may occur in one eye or both; the number of lesions varies between patients. Chorodial tubercules may serve as important symptoms of miliary tuberculosis, since their presence can often confirm suspected diagnosis.
  • Lastly, between 10 and 30% of adults, and 20–40% of children with miliary tuberculosis have tuberculosis meningitis. This relationship results from myobacteria from miliary tuberculosis spreading to the brain and the subarachnoid space; as a result, leading to tuberculosis meningitis

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes Miliary tuberculosis?

Miliary tuberculosis is a form of tuberculosis that is the result of mycobacterium tuberculosis traveling to extra-pulmonary organs, such as the liver, spleen and kidneys. Although it is well understood that the bacteria spread from the pulmonary system to the lymphatic system and eventually the blood stream, the mechanism by which this occurs is not well understood.

Tuberculous infection in the lungs results in erosion of the epithelial layer of alveolar cells and the spread of infection into a pulmonary vein. Once the 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 the granuloma, giving the typical appearance of miliary tuberculosis.

The bacteria may attack the cells lining the alveoli and enter the lymph nodes. The bacteria then drain into a systemic vein and eventually reach the right side of the heart. 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.

Risk factors

The risk factors for contracting Miliary tuberculosis are:

  • Being in direct contact with a person who has this disease
  • Living in unsanitary conditions
  • Having an unhealthy diet.

Besides, risk factors for contracting the disease include homelessness and HIV/AIDS.

Diagnosis &treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is miliary tuberculosis diagnosed?

Testing for miliary tuberculosis is conducted in a similar manner as for other forms of tuberculosis, although a number of tests must be conducted on a patient to confirm diagnosis. Tests include:

  • Chest x-ray
  • Sputum culture,
  • Bronchoscopy
  • Open lung biopsy
  • Head CT/MRI
  • Blood cultures
  • Fundoscopy
  • Electrocardiography.

The tuberculosis blood test or interferon Gamma Release Assay or IGRA, is a way to diagnose latent tuberculosis. A variety of neurological complications have been noted in miliary tuberculosis patients—tuberculous meningitis and cerebral tuberculomas being the most frequent. However, a majority of patients improve following antituberculous treatment. Rarely lymphangitic spread of lung cancer could mimic miliary pattern of tuberculosis on regular chest X-ray.

The tuberculin skin test, commonly used for detection of other forms of tuberculosis, is not useful in the detection of miliary tuberculosis. The tuberculin skin test fails due to the high numbers of false negatives. These false negatives may occur because of higher rates of tuberculin anergy compared to other forms of tuberculosis.

How is military tuberculosis treated?

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 U.S. guidelines recommend nine months’ treatment. “Common medication side effects a patient may have such as inflammation of the liver if a patient is taking pyrazinamide, rifampin, and isoniazid. A patient may also have drug resistance to medication, relapse, respiratory failure, and adult respiratory distress syndrome.”

Lifestyle changes &home remedies

What are some lifestyle changes or home remedies that can help me manage military tuberculosis?

The following lifestyles and home remedies might help you cope with this condition:

  • Evidence from published studies indicates that BCG vaccination is effective in reducing the incidence of miliary tuberculosis, especially in children. Therefore, it is necessary to inject this vaccination and protect yourselves from this condition
  • Or if you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: January 4, 2017 | Last Modified: January 4, 2017

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