The hematogenous distribution of tubercle bacilli to the lungs is presumably a fatal variation of the disseminated disease. John Jacobus Manget initially used the term miliary tuberculosis in 1700 to describe a pathological specimen with tiny tubercles that looked like millet seeds.
Its root is the millet-seed-related Latin term miliarius. The characteristic sign that supports the diagnosis of miliary tuberculosis on a chest radiograph is miliary mottling. Both extrapulmonary and pulmonary tuberculosis is categorized as miliary tuberculosis.
Epidemiology
Due to the widespread use of immunosuppressants and chemotherapy, biological agents, as well as the rising incidence of chronic kidney disease, diabetes mellitus, alcoholism, the emergence of the pandemic, organ transplantation, and immigration from high endemic countries, the epidemiological patterns of military tuberculosis have changed.
According to the World Health Organization’s Global Tuberculosis Report, 1.3 million people worldwide died from the disease in 2018, while an estimated 10 million people contracted TB.
In the United States, there were 8920 new cases of tuberculosis reported for the year 2019, according to the Centers for Disease Control and Prevention. About 1 to 2% of all tuberculosis cases and up to 20% of all extrapulmonary tuberculosis cases in immunocompetent people are caused by miliary tuberculosis.
Before the development of antibiotics, it was believed that newborns and young children were only susceptible to miliary tuberculosis. However, the disease currently has a bimodal distribution of ages, with the first peak occurring in adolescents and young adults and the second peak appearing in the elderly, with a slight male predominance.
Anatomy
Pathophysiology
Massive lymphohematogenous M. tuberculosis diffusion from a pulmonary or extrapulmonary center and embolization to the vascular beds of several organs are the key events in the development of miliary TB.
The most affected organs are the meninges, bone marrow, lungs, spleen, and liver. The profusion of phagocytic cells in the sinusoidal wall of these organs is the most plausible cause of this distribution.
Miliary TB can occasionally be brought on by the concurrent reactivation of multiple foci in distinct organs. Both during the initial infection and later, when a dormant focus is reactivated, this reactivation might occur. When miliary TB occurs during primary disease, the illness manifests acutely and advances quickly.
Etiology
Mycobacterium tuberculosis is the perpetrator behind mild TB. As a natural reservoir, humans act as the host. The Mycobacterium TB complex includes M. tuberculosis as well as M. bovis, M. microti, and M. africanum.
Atypical mycobacterial or non-tuberculous organisms are different types of mycobacteria from tuberculous mycobacteria. M. tuberculosis is an intracellular, non-spore-forming, obligate-aerobic, facultative, catalase-negative bacteria.
It has been stained with Ziehl-Neelsen stain and is gram stain neutral. Because the mycolic acids in their cell walls offer acid fastness when decolorized with acid-alcohol, these bacteria are also known as alcohol and acid-fast bacilli.
Genetics
Prognostic Factors
If not treated effectively, miliary TB has a significant morbidity and fatality rate. The most critical factor responsible for mortality appears to be the delay in diagnosis and the failure to initiate appropriate antituberculosis treatment. The mortality rate from miliary TB ranges between 15 and 20% in children and can reach 30% in adults.
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
Future Trends
Media Gallary
References
https://www.ncbi.nlm.nih.gov/books/NBK562300/
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The hematogenous distribution of tubercle bacilli to the lungs is presumably a fatal variation of the disseminated disease. John Jacobus Manget initially used the term miliary tuberculosis in 1700 to describe a pathological specimen with tiny tubercles that looked like millet seeds.
Its root is the millet-seed-related Latin term miliarius. The characteristic sign that supports the diagnosis of miliary tuberculosis on a chest radiograph is miliary mottling. Both extrapulmonary and pulmonary tuberculosis is categorized as miliary tuberculosis.
Due to the widespread use of immunosuppressants and chemotherapy, biological agents, as well as the rising incidence of chronic kidney disease, diabetes mellitus, alcoholism, the emergence of the pandemic, organ transplantation, and immigration from high endemic countries, the epidemiological patterns of military tuberculosis have changed.
According to the World Health Organization’s Global Tuberculosis Report, 1.3 million people worldwide died from the disease in 2018, while an estimated 10 million people contracted TB.
In the United States, there were 8920 new cases of tuberculosis reported for the year 2019, according to the Centers for Disease Control and Prevention. About 1 to 2% of all tuberculosis cases and up to 20% of all extrapulmonary tuberculosis cases in immunocompetent people are caused by miliary tuberculosis.
Before the development of antibiotics, it was believed that newborns and young children were only susceptible to miliary tuberculosis. However, the disease currently has a bimodal distribution of ages, with the first peak occurring in adolescents and young adults and the second peak appearing in the elderly, with a slight male predominance.
Massive lymphohematogenous M. tuberculosis diffusion from a pulmonary or extrapulmonary center and embolization to the vascular beds of several organs are the key events in the development of miliary TB.
The most affected organs are the meninges, bone marrow, lungs, spleen, and liver. The profusion of phagocytic cells in the sinusoidal wall of these organs is the most plausible cause of this distribution.
Miliary TB can occasionally be brought on by the concurrent reactivation of multiple foci in distinct organs. Both during the initial infection and later, when a dormant focus is reactivated, this reactivation might occur. When miliary TB occurs during primary disease, the illness manifests acutely and advances quickly.
Mycobacterium tuberculosis is the perpetrator behind mild TB. As a natural reservoir, humans act as the host. The Mycobacterium TB complex includes M. tuberculosis as well as M. bovis, M. microti, and M. africanum.
Atypical mycobacterial or non-tuberculous organisms are different types of mycobacteria from tuberculous mycobacteria. M. tuberculosis is an intracellular, non-spore-forming, obligate-aerobic, facultative, catalase-negative bacteria.
It has been stained with Ziehl-Neelsen stain and is gram stain neutral. Because the mycolic acids in their cell walls offer acid fastness when decolorized with acid-alcohol, these bacteria are also known as alcohol and acid-fast bacilli.
If not treated effectively, miliary TB has a significant morbidity and fatality rate. The most critical factor responsible for mortality appears to be the delay in diagnosis and the failure to initiate appropriate antituberculosis treatment. The mortality rate from miliary TB ranges between 15 and 20% in children and can reach 30% in adults.
https://www.ncbi.nlm.nih.gov/books/NBK562300/
medtigo
Miliary tuberculosis
Updated :
November 17, 2022
The hematogenous distribution of tubercle bacilli to the lungs is presumably a fatal variation of the disseminated disease. John Jacobus Manget initially used the term miliary tuberculosis in 1700 to describe a pathological specimen with tiny tubercles that looked like millet seeds.
Its root is the millet-seed-related Latin term miliarius. The characteristic sign that supports the diagnosis of miliary tuberculosis on a chest radiograph is miliary mottling. Both extrapulmonary and pulmonary tuberculosis is categorized as miliary tuberculosis.
Due to the widespread use of immunosuppressants and chemotherapy, biological agents, as well as the rising incidence of chronic kidney disease, diabetes mellitus, alcoholism, the emergence of the pandemic, organ transplantation, and immigration from high endemic countries, the epidemiological patterns of military tuberculosis have changed.
According to the World Health Organization’s Global Tuberculosis Report, 1.3 million people worldwide died from the disease in 2018, while an estimated 10 million people contracted TB.
In the United States, there were 8920 new cases of tuberculosis reported for the year 2019, according to the Centers for Disease Control and Prevention. About 1 to 2% of all tuberculosis cases and up to 20% of all extrapulmonary tuberculosis cases in immunocompetent people are caused by miliary tuberculosis.
Before the development of antibiotics, it was believed that newborns and young children were only susceptible to miliary tuberculosis. However, the disease currently has a bimodal distribution of ages, with the first peak occurring in adolescents and young adults and the second peak appearing in the elderly, with a slight male predominance.
Massive lymphohematogenous M. tuberculosis diffusion from a pulmonary or extrapulmonary center and embolization to the vascular beds of several organs are the key events in the development of miliary TB.
The most affected organs are the meninges, bone marrow, lungs, spleen, and liver. The profusion of phagocytic cells in the sinusoidal wall of these organs is the most plausible cause of this distribution.
Miliary TB can occasionally be brought on by the concurrent reactivation of multiple foci in distinct organs. Both during the initial infection and later, when a dormant focus is reactivated, this reactivation might occur. When miliary TB occurs during primary disease, the illness manifests acutely and advances quickly.
Mycobacterium tuberculosis is the perpetrator behind mild TB. As a natural reservoir, humans act as the host. The Mycobacterium TB complex includes M. tuberculosis as well as M. bovis, M. microti, and M. africanum.
Atypical mycobacterial or non-tuberculous organisms are different types of mycobacteria from tuberculous mycobacteria. M. tuberculosis is an intracellular, non-spore-forming, obligate-aerobic, facultative, catalase-negative bacteria.
It has been stained with Ziehl-Neelsen stain and is gram stain neutral. Because the mycolic acids in their cell walls offer acid fastness when decolorized with acid-alcohol, these bacteria are also known as alcohol and acid-fast bacilli.
If not treated effectively, miliary TB has a significant morbidity and fatality rate. The most critical factor responsible for mortality appears to be the delay in diagnosis and the failure to initiate appropriate antituberculosis treatment. The mortality rate from miliary TB ranges between 15 and 20% in children and can reach 30% in adults.
https://www.ncbi.nlm.nih.gov/books/NBK562300/
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