Miliary tuberculosis

Although infections are generally thought to be particularly frequent and possibly severe in patients treated with steroids, they have been used as short-term adjunctive therapy to reduce the severe symptoms associated with such bacterial infections as acute H. influenzae and miliary tuberculosis and in viral infections, such as hepatitis and infectious mononucleosis. 

Tuberculosis (TB) is an infection with mycobacterium causing the presence of tubercles. The most common single source of infection is the lungs. If the tubercles are within the blood and more than two tissues sites (e.g. lungs and liver) then it is called miliary tuberculosis. Tuberculosis is caused by Mycobacterium tuberculosis or more rarely Mycobacterium bovis. Infection spreads by inhalation of infected droplets. 

Godwin, J.E., Coleman, AA., Sahn, St.A. Miliary tuberculosis presenting as hepatic and renal failure. Chest 1991 99 752—754... 

The tuberculous primary complex in the liver with caseation of the associated hepatic hilar lymph nodes may become the source of spread causing early systemic generalization. Given the clinical picture of a coarse-nodular or a miliary tuberculosis, this may result in the death of the newborn child. 

In the course of healing, miliary tuberculosis or small diffuse disseminated foci give rise to scarred transformation with the morphological picture of tuberculous pseudocirrhosis as a result of vascularization, fibroblasts and histiocytic connective tissue. As a rule, however, no major hepatic dysfunction results from the cicatrization of the healing process, which no longer (or barely) exhibits the specific character of granulation tissue. 

Asada, Y., Hayashi, T., Sumiyoshi, A., Aburaya, M., Shishime, E. Miliary tuberculosis presenting as fever and jaundice with hepatic failure. Hum. Pathol. 1991 22 92-94... 

Reactivation of latent tuberculosis is a major concern with infliximab (SEDA-26, 402), and accounts for about one-third of infections in these patients. According to data from the manufacturers, 130 cases of active tuberculosis were notified up to October 2001. Many of the cases were disseminated or extrapulmonary tuberculosis, and several patients died. Several case reports have provided detailed information in at least seven other patients, including three who developed miliary tuberculosis and one who developed Mycobacterium tuberculosis enteritis (44-48). A detailed analysis of 70 cases of tuberculosis reported to the FDA has been published (49). Two-thirds of the cases were noted after three or fewer infusions and 57% of the patients had extrapulmonary disease. There were 64 cases from countries with a low incidence of tuberculosis. From these reports and the number of patients treated with infliximab, the estimated rate of tuberculosis in patients with rheumatoid arthritis treated with infliximab was four times higher than the background rate. Patients with evidence of active infection should not receive infliximab until the infection is under control all should be screened for tuberculosis before starting infliximab (50). From these and other data it has been estimated that the risk of tuberculosis in the first year of infliximab treatment is 0.035 in US citizens and 0.2% in non-US citizens. Further investigations, such as a chest X-ray and a Mantoux test, and prophylactic treatment with isoniazid, will show whether the incidence can be reduced in patients taking anti-TNF treatment (51). 

Mayordomo L, Marenco JL, Gomez-Mateos J, Rejon E. Pulmonary miliary tuberculosis in a patient with anti-TNF-alpha treatment. Scand J Rheumatol 2002 31(l) 44-5. 

Rovere Querini P, Vecellio M, Sabbadini MG, Ciboddo G. Miliary tuberculosis after biological therapy for rheumatoid arthritis. Rheumatology 2002 41(2) 231. 

Tuberculosis. Korn et al. (K30) reported serum alkaline phosphatase elevation in 41% of a group of patients with extrapulmonary tuberculosis and claimed that elevated values tended to be associated with granulomatous infiltration of the liver. Munt (M40) found hyperphosphatasemia in 34% of patients with miliary tuberculosis, but could demonstrate no correlation between serum alkaline phosphatase and liver histology. Many of the patients studied by Korn et al. (K30) had fatty... 

M30. Munt, P. W., Miliary tuberculosis in the chemotherapy era With a clinical review in 69 American adults. Medicine 51, 139-155 (1972). 

Items 8-9 A 54-year-old man with miliary tuberculosis has developed signs of severe acute adrenal insufficiency. 

Miliary tuberculosis Type of tuberculosis that invades all tissues producing tiny lesions. 

Tuberculosis associated with miliary tuberculosis rarely localized... 

As the disease progresses, subpleural emphysema and the formation of thin-waUed subpleural cysts are pathognomonic findings in PAM and might represent early lung fibrosis. The subpleural cysts are accountable for the black subpleural line on chest X-rays (Korn et al. 1992). The main differential diagnoses include miliary tuberculosis, sarcoidosis, metastatic pulmonary calcification associated with hemodialysis, sihcosis, and pulmonary hemosiderosis. 

But he was not a well man. He suffered from miliary tuberculosis that invaded his entire body, forcing him into retirement early in 1846. He died on 22 June 1847. 

Tissot C, Couraud S, Meng L, Girard P, Avrillon V, Genniere L, et al. life-threatening disseminated tuberculosis as a complication of treatment by infliximab for Crohn s disease report of two cases, including cerebral tuberculomas and miliary tuberculosis. J Crohns Colitis... 

About 1.8 billion individuals, or about one-third of the world s population, are infected with Mycobacterium tuberculosis, and most of these individuals have latent infection. Although malnutrition is a major risk factor for the progression of tuberculosis, tuberculosis control programs have tended to focus upon chemoprophylaxis and chemotherapy alone, rather than upon improvement of host nutritional status. For over one hundred years, cod-liver oil, a rich source of vitamins A and D, was used as a treatment for tuberculosis. The role of nutrition and tuberculosis remains a major area of neglect, despite the promise that micronutrients have shown as therapy for other types of infections and the long record of the use of vitamins A and D for treatment of pulmonary and miliary tuberculosis in both Europe and the United States. A recent clinical trial suggests that high dose vitamin A supplementation does not alter the morbidity of tuberculosis in children [65]. Studies have not been conducted which address the use of multivitamins and minerals or vitamins A plus D as an adjunct therapy for tuberculosis. 

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