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Disseminated TB - An Overview

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Mycobacterium tuberculosis spreads hematogenously to generate life-threatening disseminated TB. It affects the underlying organs, making diagnosis difficult.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At January 2, 2024
Reviewed AtJanuary 2, 2024

What Is Disseminated TB?

Disseminated tuberculosis, also known as TB, is characterized by the presence of two or more noncontiguous sites that are caused by the hematogenous diffusion of Mycobacterium tuberculosis. This could happen as a result of a consequence of a primary infection that is advancing, the active component of a dormant focus that has subsequently disseminated, or, in extremely unusual instances, an iatrogenic cause. Even if the traditional radiologic or pathologic symptoms are not present, it still requires a hematogenous illness to spread to multiple organs. This is the case even if the disease is not detectable by pathology.

What Are the Signs and Symptoms?

Individuals with miliary tuberculosis can develop progressively worsening symptoms over several days or weeks or, on rare occasions, months. Among the symptoms are the following:

  • Weakness and weariness.

  • Weight reduction.

  • Headache.

  • Mild symptoms, including low-grade fever.

  • Fever.

  • Cough.

  • Systemic lymphadenopathy - Systemic viral infections are most frequently linked to generalized lymphadenopathy.

  • Hepatomegaly (an abnormally massive liver).

  • Splenomegaly (characterized by splenic enlargement, either in terms of size or mass).

  • Pancreatitis.

  • Multiorgan failure, renal and hepatic impairment.

What Are the Causes of the Condition?

Immunosuppression is associated with the following risk variables for military tuberculosis:

  • Carcinoma.

  • Transplantation.

  • Infection by HIV.

  • Undernutrition.

  • Diabetes.

  • Silicosis (a chronic lung condition brought on by the prolonged inhalation of crystalline silica dust).

  • Chronic renal insufficiency.

  • Massive surgical operations (can, on occasion, cause dissemination).

What Are the Diagnostic Methods?

  • Biochemical Test: A reduction in sodium levels may be associated with illness severity, and a syndrome of improper secretion by antidiuretic hormone (SIADH) or hypoadrenalism can aggravate tuberculosis (TB). In rough, the levels of alkaline phosphatase are increased. Transaminase elevations indicate liver dysfunction or, if therapy has been commenced, medication toxicity.

  1. Blood Count Total: Miliary TB may exhibit leukopenia or leukocytosis. There may be leukemoid responses, anemia, thrombocytopenia, or, in rare cases, thrombocytosis.

  2. Sedimentation Rate of Erythrocytes: Around fifty percent of patients have an increased erythrocyte sedimentation rate.

  3. Investigation on Coagulation: Prior to performing a biopsy, the prothrombin time and partial thromboplastin activation time should be determined.

  4. Skin Test for Tuberculin: In patients with miliary tuberculosis, a tuberculin skin test with a pure protein derivative (PPD) frequently produces negative results. This may be due to the high quantity of TB antigens present in the body. Negative findings from a tuberculosis skin test do not rule out the possibility of TB.

  5. Nucleic Acid Probes: The specificity for smear- and culture-negative material is less than one hundred percent (false-negative results). The approximate five percent rate of false-positive TB culture results is cause for alarm. This may be caused by contamination in the laboratory.

In the majority of instances of HIV-associated disseminated tuberculosis, polymerase chain reaction analysis of blood may produce positive results; however, the yield is low for non-HIV-associated miliary TB.

  1. Mycobacteria Cultures

  • Sputum, blood, urine, and CSF cultures are accessible. All positive isolates should be tested for MDR-TB and sensitivity. TB can occur even with three negative sputum smears.

  • Non-HIV patients have positive mycobacterial blood cultures. HIV patients have positive results. One study found positive.

  • Also, with clear brain MRI results, lumbar puncture should be highly considered and may indicate any one of the following:

  1. Leukocytes.

  2. Lymphocytic dominance.

  3. Mildly increased CSF lactic acid.

  4. Protein excess.

  5. Low glucose.

  6. Frequent RBCs.

  7. Acid-fast bacilli.

2. Image Diagnosis

  1. Chest Radiograph- Miliary nodules are made visible by a bright light. Bilateral pleural effusions, as opposed to localized or unilateral pleural TB, imply spread. This may be a valuable clinical indicator. In lateral chest radiographs, nodules typical of miliary tuberculosis may be more visible.

  2. CT Scans of the Chest - Chest CT offers greater accuracy and precision than chest radiography for detecting well-defined, randomly distributed nodules. A high-resolution CT scan could be even more beneficial. It is beneficial in the context of both intriguing and inconclusive chest X-ray findings.

  3. Ultrasonography - Ultrasonography has the ability to detect extensive liver disease, hepatomegaly, splenomegaly, and para-aortic lymph nodes.

  4. Brain MRI or Contrast-Enhanced CT Scan of the Head - Use this to identify potential TB lesions. Lumbar puncture may raise the likelihood of herniation in patients with hydrocephalus or a brain mass lesion (tuberculoma).

  5. Abdominal CT Scanning- Abdominal CT scans can detect para-aortic lymph nodes, hepatosplenomegaly, and tuberculous abscesses.

  6. Echocardiography - Echocardiography has the highest sensitivity for detecting pericardial effusion.

  7. Other military tuberculosis tests and procedures include the following:

  • Nucleic acid probes.

  • Tuberculin skin test.

  • Coagulation studies.

  • Cultures for mycobacteria.

  • Erythrocyte sedimentation rate.

  • Complete blood count.

  1. Funduscopy - It can indicate the presence of retinal tubules.

What Is the Treatment Method?

The primary goal of the treatment is to successfully eradicate the infection with antibacterial drugs. To effectively treat disseminated tuberculosis, a combination of many medications is required. Patients may be required to take a range of drugs for at least six months. It is essential to take the medication as advised. According to the directions issued by a skilled physician, the recommended medication may need to be taken twice or even three times per week. Individuals with the illness may be isolated at home or in a medical facility for two to four weeks to prevent the disease's spread and guarantee that they are no longer contagious.

What Is the Preventive Method?

Even in people who have been in contact with an infected person, tuberculosis (TB) is a disease that can be avoided through proper hygiene and medication. Those who are at a high risk of contracting tuberculosis or who may have been exposed to the disease in the past, such as those who work in health care, are given a skin test for the disease.

Individuals who have been in contact with someone who has tuberculosis should undergo a TB skin test as soon as possible, and if the results of that test come back negative, they should do a second test at a later time. If a tuberculosis skin test is positive, this indicates that they have had direct or indirect contact with the TB bacterium. It does not indicate that the person is now suffering from the disease or that it is contagious. Receiving treatment as soon as possible is of the utmost importance. To reduce the number of people who become infected with tuberculosis (TB), a vaccination known as BCG is administered to the population.

Conclusion

There is a tremendous burden of illness and mortality associated with disseminated tuberculosis, making it one of the most critical health problems on a global scale. The vague clinical picture combined with the restricted diagnostic tools available in the laboratory makes it extremely challenging to arrive at an accurate diagnosis. Increased awareness of this condition and the associated patterns may lead to an improvement in the index of suspicion possessed by clinicians, which in turn will result in a more effective diagnostic strategy. Therefore, patients with immunosuppression, such as HIV patients, patients with organ transplantation and chronic liver diseases, and patients from endemic areas, who present with prolonged fever of unknown origin, weight loss, lassitude, hepatomegaly, splenomegaly, liver function abnormalities, and unusual hematological indices should be targeted with determined efforts to diagnose and treat the disease as soon as possible.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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