Abstract
Aim: Miliary tuberculosis (MTB) is a serious and rare form of tuberculosis. Studies comparatively reviewed children and adults with MTB are lacking. Methods: We retrospectively evaluated 56 pediatric and 26 adult MTB patients at a university hospital, between 1990 and 2003 Results: The median age at presentation was 3.5 years for children and 38 years for adults. Thirtyeight of all patients of whom 86.8% were children had family history of tuberculosis Presenting symptoms and signs of adult and pediatric patients were loss of weight (51.8% vs. 61.5%), anorexia (76.9% vs. 57.8%), dyspnea (12.5% vs. 57.8%), diarrhea/vomiting (35.0% vs. 27.0%), fever (53.8% vs. 17.9%), hepatomegaly (30.8% vs. 51.8%), pulmonary crepitations (42.3% vs. 42.9) and cough (46.2% vs. 35.7%), respectively. The presenting symptoms/signs and laboratory abnormalities were generally more frequent in adults. Detected laboratory abnormalities were leukocytosis (73.2%), increased sedimentation rate (73.2%), anemia (52.4%), hypoalbuminemia (47.6%), elevated liver transaminases (36.6%), elevated lactate dehydrogenase (50.0%) and hyponatremia (25.6%) in whole study group. The diagnosis was proven microbiologically in 15 (18.3%) patients. Among 56 pediatric cases, there were 8 (14.3%) children with positive BCG scar and only 16 (28.6%) children with positive reaction to 5TU tuberculin test. Radiological findings of all patients, either on chest X-ray or high resolution computerized tomography, were characteristic for MTB. One fourth of patients had accompanying tuberculous meningitis. Predisposing factors for TB were found in 13 patients (15.9%). No patients had HIV infection. Overall 6 (7.3%) patients had died. Conclusion: High rate of history of family contact and low rate of BCG vaccination in our patients with MTB were significant public health problems. Identifying different features in children and adults may contribute to early diagnosis of MTB, which is highly relevant to its outcome.
Highlights
One-third of the world’s population (1.7 billion people) is infected with the tuberculous (TB) bacilli [1]
The diagnosis of Miliary tuberculosis (MTB) was based on the presence of miliary pattern on chest radiograph and/or typical findings on high resolution computerized tomography (HRCT), along with one or more of the following features: 1) clinical features compatible with tuberculosis, 2) positive smear or culture for Mycobacterium tuberculosis, 3) histopathological evidence of TB
The percent of accompanying TB meningitis were similar in children (25.0%) and adults (23.1%) with MTB (p>0.05) (Table 1)
Summary
One-third of the world’s population (1.7 billion people) is infected with the tuberculous (TB) bacilli [1]. Due to advent of HIV/AIDS and the resurgence of TB, global attention has been focused on adult forms of TB, and there is a real danger that TB in children may be overlooked. The signs and symptoms of TB in children are so vague that diagnosis is often difficult. Miliary tuberculosis (MTB) results from the acute hematogenous dissemination of TB bacilli in lungs and other organs, where. 0.047 0.002 ns to investigate the clinical, radiological and laboratory characteristics, outcome and risk factors of pediatric and adult patients with MTB in a comperative manner at a non-HIV area in order to obtain an early diagnosis and treatment of MTB
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