Miliary tuberculosis

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1. AZERBAIJAN MEDICAL UNIVERSITY NAME: ZAKARYA KAMAL SATTOUF GROUP: 180B SUBJECT: MILIARY TUBERCULOSIS DATE; 12/7/2019 1

2. INTRODUCTION Definition History Risk factors Types and forms Pathophysiology of miliary TB Clinical findings Diagnosis Differentiation Treatment Complication prevention References 2

3. DEFINITION Miliary TB is an a form of disseminated TB or Extra pulmonary TB that is caused by sudden diffuse dissemination of tubercli bacili through the bloodstream ( hematogenous spread of TB ) The foci are possible caseous - necrotic changes. Focal changes develop in the interstitial tissues In miliary TB foci formed small ( 1-2 mm ) with productive tissue reaction Small foci look like millet grains 3

4. Miliary Tuberculosis: mainly occurs in children and young adults but may also occur in older people and it is insidious in onset in this older age group Miliary TB : is can be difficult to diagnose especially in older age group in which case it is known as  Cryptic Tuberculosis  (because of its insidious onset

5. HISTORY Miliary TB got its name in 1700 from John Jacob Manget  based on how it appears on autopsy findings . The bodies would have a lot of very small spots similar to hundreds of tiny seeds about 2 millimeters long scatted in various tissues. Since a millet seed is about that size , the condition became known as miliary TB

6. Small foci like millet seed which is scatted in various tissues

7. RISK FACTORS • Age – Child & Elderly • Immunosuppression • Cancer • Transplantation • HIV • Malnutrition • Diabetes • Silicosis • End-stage renal disease 4

8. The miliary TB can be develop in the Miliary pulmonary tuberculosis : occurs when the organisms draining through the lymphatic and pulmonary arterioles and enter to the venous blood and circulate back to the lung Systemic miliary tuberculosis ; occurs when bacteria disseminate through the systemic arterial system. TYPES

9. MILIARY TB SEPSIS POLMONARY TYPHOIDAL MENINGITIC THE MAIN CLINICAL FORMS OF MILIARY TB

10. PATHOPHYSIOLOGY OF MILIARY TB • Tuberculosis infection in the lungs results in erosion of the epithelial layer of alveolar cells and the spread of infection into a pulmonary vein • 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 granuloma, giving the typical appearance of miliary tuberculosis 5

11. CLINICAL FINDINGS Patients may not be acutely ill Symptoms include Weakness and fatigue (90%) Fever and weight loss (80%) Chills , night sweats are common Cough , Hemoptysis Anorexia Hepatomegaly and lymphadenopathy are common 6

12. DIAGNOSIS CBC - Leukopenia/leukocytosis ESR - elevated in approximately 50% of patients Lumbar puncture - strongly considered Lymphocytic predominance (70%) Elevated protein levels (90%) Low glucose levels (90%) Acid-fast bacilli (≥40%) Cultures for mycobacteria PCR 7

13. • Typical appearance only in 50% of cases • Bilateral pleural effusions indicate dissemination. This may be a useful clue. • Nodules characteristic of miliary TB may be better visualized on lateral chest radiography (especially in the retro cardiac space). • Nodules are the size of millet seeds ( 1-5mm, mean=2mm) CHEST X-RAY 8

14. CT SCAN

15. The typhus begins with gradually developing of weakness and increase of temperature Bradycardia leucopenia lymphocytosis Widal’s reaction can be positive just in typhus Breathlessness Cyanosis Tachycardia irregular type fever absence of dyspeptic disturbances leucocytes within the limits of norm or leucocytosis up to 15 000-18 000   lymphopenia Monocytosis Roentgenograms confirm suspicions on miliary lung tuberculosis MILIARY TUBERCULOSIS ABDOMINAL TYPHUS 9

16. • Four-drug regimen to start Isoniazid Rifampin Pyrazinamide Ethambutol or streptomycin • Treatment may continue for 6-9 months • 9-12 months with meningeal involvement TREATMENT 10

17. • Dissemination via bloodstream to Prostate Seminal vesicles Epididymis Fallopian tubes Endometrium Meninges Lymph nodes Liver Spleen Skeleton Kidneys Adrenals COMPLICATIONS 11

18. BCG vaccination Effective in reducing the incidence of miliary tuberculosis Not effective in individuals who are already infected Should not be administered to immunosuppressed hosts Targeted tuberculin testing Treatment of latent tuberculosis infection PREVENTION

19. REFERENCES: https://www.slideshare.net/chaudharymahesh/miliary-tuberculosis-dr-mahesh http://tuberkulez-forever.com/tuberkulez-likbez/eng https:// www.slideshare.net/DeepakKumarGupta2/granulomatous-inflammation-tuberculosis-syphillis https:// www.slideshare.net/ghalan/pulmonary-tuberculosis-2941528 https://slideplayer.com/slide/10787857 / https:// en.wikipedia.org/wiki/Jean-Jacques_Manget https:// www.slideshare.net/chaudharymahesh/miliary-tuberculosis-dr-mahesh https:// www.youtube.com/watch?v=9HUmsnp-nYg https:// www.healthline.com/health/miliary-tuberculosis 12