Miliary tuberculosis
Miliary tuberculosis: how to stop the disease in time
Miliary tuberculosis is a dangerous form of tuberculosis that occurs without a pronounced lymphogenic stage. Tuberculous tubercles can form in various organs. The spread of the pathogen is hematogenic.
Miliary tuberculosis is a disease with a potential fatal outcome, however, with timely treatment, it is amenable to therapy. The main danger of this pathology is that miliary tuberculosis is difficult to diagnose, the clinical picture of this disease is usually blurred.
In the ICD-10, miliary tuberculosis is included under the number A19. Due to the characteristic pathogenesis (spread with blood and lymph), miliary tuberculosis is considered one of the forms of disseminated tuberculosis.
Forms of miliary tuberculosis
Acute miliary tuberculosis:
a) of specified localization;
b) unspecified localization;
c) multiple localization.
Acute tuberculous sepsis.
Miliary tuberculosis of unspecified localization.
Extensive acute miliary tuberculosis with localization in the lungs.
Generalized tuberculous polyserositis.
The most dangerous form of miliary tuberculosis is acute tuberculous sepsis. A fatal outcome in this case is possible two to three weeks after the appearance of the first symptoms.
In addition, there is a chronic form of miliary tuberculosis, in which periods of exacerbation are replaced by remissions.
Pathogenesis and causes of the disease
Mycobacterium bacteria are the causative agent of miliary tuberculosis. In total, there are 74 species of these microorganisms known to science, but we are talking mainly about human and bovine species (both dangerous to humans) – Mycobacterium tuberculosis and Mycobacterium bovis. Microorganisms that cause tuberculosis are briefly referred to by the abbreviation MBT (Mycobacterium tuberculosis).
In children, miliary tuberculosis in most cases is a consequence of primary tuberculosis and develops immediately after infection. In adults, the disease can develop from the reactivation of hematogenous dropouts.
The penetration of MBT into the body usually occurs by airborne droplets (other methods of infection are possible, but are less common). Normally, the respiratory system has a protective mechanism consisting in the formation of mucus binding mycobacteria and its subsequent excretion. However, if this mechanism does not work (due to inflammatory processes or exposure to toxic substances), bacteria enter the lungs. For some time, ICD multiply very slowly, without causing a response from the body. Then they spread through various tissues and organs along with the lymph flow and begin to multiply more aggressively. In the affected organs, many small tuberculous tubercles, the size of a grain of millet, are formed. The foci may eventually grow and merge.
In the case of alimentary (with food), contact or transplacental infection, the lungs can avoid damage, but in this case the diagnostic process becomes more complicated, since radiography is the easiest way to detect miliary tuberculosis.
Symptoms of miliary tuberculosis
Subjective symptoms of this disease are mild, without specific manifestations. Usually patients complain of general malaise, weakness, fever, shortness of breath and cough. A frequent symptom is also a severe weight loss for no apparent reason.
Diagnosis of miliary tuberculosis
It is often very difficult to detect the disease. Due to the reduced resistance of the body, the reaction to the Mantoux test is often negative. Radiography and laboratory analysis of sputum also do not always help to identify the disease. In case of suspicion of any form of miliary tuberculosis, a thorough examination is necessary, including anamnesis, clinical studies of blood, urine and sputum, and radiography.
Treatment and prognosis
The prognosis strongly depends on the form and stage of the disease. The main method of treatment is combined antibiotic therapy (consisting of 4-5 drugs), which is accompanied by taking immunomodulatory drugs and a special regime (bed or sanatorium, depending on the patient’s condition). The duration of treatment is about 12 months.
In case of suspicion of severe forms of the disease (especially acute tuberculosis sepsis), it is advisable to prescribe trial therapy even before making an accurate diagnosis.
