Miliary Tuberculosis In Children Research Articles

A simultaneous case miliary tuberculosis presenting with tuberculous meningitis: a case report

Background: Miliary tuberculosis in children could occur 20-40% simultaneously with tuberculous meningitis (TBM). Dissemination of the tuberculous bacilli from the lungs to the meninges leads to the formation of small tuberculomas, leading to TBM. Despite the availability of effective therapy, diagnosis is usually late, and mortality remains high. Case Presentation: A 15-year-old boy came to our emergency ward with the chief complaint of loss of consciousness two days before admission. The patient had a fever in the past month. Fever occurred in several episodes along with cough. The patient had a headache five days before admission. Projectile vomiting was denied. The patient had lost about five kilograms in the last month. Vital signs are stable and within normal limits. Physical examination showed lethargy, neck stiffness, and an enlarged lymph node on the neck. Neurologic examination was normal. Chest X-ray showed miliary opacities scattered over both lung fields. Cerebrospinal fluid (CSF) examination showed clear with low glucose and high cell count suggested to TBM. No bacteria were found in the CSF culture sample. A contrast head computed tomography (CT) scan revealed a leptomeningeal contrast enhancement. Active communicating hydrocephalus was also seen on a head CT scan. Eventually, Mycobacterium was detected in the gastric fluid. The patient was diagnosed with tuberculous meningitis. This patient was treated in an intensive phase of anti-tuberculous therapy and continued with an advanced phase. Conclusion: We reported cases of miliary tuberculosis simultaneously with tuberculous meningitis in a 15-year-old patient. The timely diagnosis and management will reduce morbidity and mortality.

State-of-the-art of miliary tuberculosis in children: protocol for a scoping review of the literature

Background: Miliary Tuberculosis (TB) is a rare manifestation of TB described in both adults and children. Pediatirc reports are rare and therefore evidence about diagnostics and management is scarce. Methods: We will start our research in March 2023 in the following bibliographic databases: PubMed, EMBASE, Cochrane and SCOPUS. The main review question will be “What are the main clinical characteristics and outcomes of pediatric miliary TB reported in the literature?” We will include randomized and non-randomized controlled trials, prospective and retrospective observational studies, performed on children and adolescents (younger than 18 years), hospitalized or not, with a confirmed diagnosis of miliary TB. To report our findings, we will follow Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Dissemination: The findings of this review will be published in international peer-reviewed journals and presented in pediatric infectious diseases national and international conferences.

Risk factors for miliary tuberculosis in children

Background Miliary tuberculosis (TB) is a fatal form of tuberculosis with severe clinical symptoms and complications. The mortality rate from this disease remains high, therefore, it is important to identify the risk factors for miliary TB for early detection and treatment.Objective To identify risk factors for miliary tuberculosis in children.Methods A case-control study of children aged 0-14 years with miliary TB was conducted in Dr. Soetomo Hospital from 2010 to 2015. Data were taken from medical records. Case subjects were children with miliary TB, and control subjects were children with pulmonary TB . Patients with incomplete medical records were excluded. Case subjects were identified from the total patient population; control subjects were included by purposive sampling, with case:control ratio of 1:1. Potential risk factors were age, nutritional status, BCG immunization status, and history of contact with TB patients. Statistical analyses were done with Chi-square and logistic regression tests. P values < 0.05 were considered to be statistically significant.Results A total of 72 children were analyzed, with 36 case and 36 control subjects. Nutritional status had a significant associatation with miliary TB in children (OR 3.182; 95%CI 1.206 to 8.398; P=0.018) in both bivariate and multivariate analyses. The probability of a child with moderate or severe undernutrition developing miliary TB was 76.09%. Other factors were not significantly associated with miliary TB.Conclusion Nutritional status is significantly associated with miliary TB in children, and moderate or severe undernutrition increases the risk for developing miliary TB.

Bilateral pneumothorax complicating miliary tuberculosis in children: case report and review of the literature

An 11-year-old boy presented with a 4-week history of fever and 2 weeks later developed a cough with breathlessness. His chest X-ray showed bilateral miliary shadows with pneumothorax on the left side. While on antituberculous therapy which was started on admission, he developed right-sided pneumothorax with significant collapse of the left lung. He was managed by tube thoracotomy with underwater seal but died 4 hours after the procedure was completed.

Miliary tuberculosis in children: a clinical review.

Miliary tuberculosis infection in childhood remains a significant health problem in developing countries. To characterize the clinical features of the disease, symptoms, signs and laboratory findings, associated infections and outcomes of the 23 children (14M, 9F) with miliary tuberculosis admitted to the Dicle University Hospital, Diyarbakir, Turkey from 1990 to 1997 were analysed. Mean age of the patients was 3.7 y ranging between 6 months and 11 y. All but 3 patients were below 6 y of age, and 5 of the patients were under 1 y of age. All of the children had not received BCG vaccination except for 1 who was immunized after the age of 5 y. Only 6 children had a positive reaction to 5 TU tuberculin test at admission to hospital. Eight of the 23 subjects were infected in the family, and all were nonHIV infected cases. All of the children were diagnosed clinically and by a miliary infiltrate visible on chest roentgenogram. Five cases had positive culture results for Mycobacterium tuberculosis. Duration of onset of symptoms prior to admission ranged between 15 d and 8 months with a mean of 58 d. The most frequently seen symptoms and clinical findings were fever in 17 cases, rales in 14, loss of appetite and weight in 10 and hepatosplenomegaly in 9 cases. Two cases had prior measles infection and 1 of the patients presented facial paralysis. Seven cases had also tuberculous meningitis. The outcome in general was good, with mortality in 2 cases.

Miliary tuberculosis in children

This is a retrospective review of the clinical, radiologic and laboratory features of 94 cases of childhood miliary tuberculosis seen during a 5-year period, 1985 to 1989. A history of Bacillus Calmette-Guérin vaccination was documented in 88% of children. The median age at presentation was 10.5 months, 52% of cases occurring in those younger than 1 year. The presenting symptoms were nonspecific: cough (72%); fever (61%); loss of appetite and weight (40%); and diarrhea and vomiting (33%). The main presenting signs were hepatomegaly (82%), splenomegaly (54%), lymphadenopathy (46%) and pyrexia (39%). Most of the patients were malnourished and anergic. Meningitis occurred in 19% of patients and this was the only significant risk factor identified for mortality, the overall case fatality rate being 14%. The diagnosis in the vast majority was made on the clinical presentation supported by a classic miliary pattern on chest roentgenogram (91% of cases). Mycobacterium tuberculosis was cultured in 33% of cases. In addition a review of hospital admissions from 1981 to 1989 revealed that annually miliary tuberculosis in children and adults accounted for 8.3 and 1.3%, respectively, of all tuberculosis admissions. This study confirms that miliary tuberculosis is a relatively common complication of tuberculosis in young children.

Evolution of Short-Course Antimicrobial Treatment of Tuberculosis in Children, 1951-1984

Although the first unrecognized indication that short-course antimicrobial treatment of tuberculosis might be effective came in reports of tuberculous meningitis and miliary tuberculosis in children so treated by Lorber (1951 to 1956), the 1977 American Lung Association-American Thoracic Society recommendation for antimicrobial therapy of tuberculosis in adults still specified an 18-month course. The first prospective study on the short-course antimicrobial treatment of children in the United States was published in December 1983. The long delay before recognition of the practicability of short-course antimicrobial treatment of tuberculosis has probably been occasioned by ignorance of drug actions and the mechanisms involved.

Miliary tuberculosis in children. Clinical and laboratory manifestation in 19 patients.

The clinical course of 19 children with miliary tuberculosis was studied. Complaints were nonspecific and included fever, anorexia, weight loss, and night sweats. Although all but one child had a miliary infiltrate visible on the chest roentgenogram, only 13 had a positive reaction to the purified protein derivative of the tuberculin test at admission to the hospital. Outcome was excellent unless the child also had tuberculous meningitis or was in a far advanced state of the disease. Miliary tuberculosis continues to be a rare but important cause of illness in the pediatric population. Seriously ill children with undiagnosed conditions of febrile disease deserve an aggressive evaluation for miliary tuberculosis, including an epidemiological survey, serial chest roentgenograms, and extensive, repeated culturing.

Miliary Tuberculosis in Children and Adults

Miliary Tuberculosis in Children and Adults

Results of specific treatment of miliary tuberculosis in children; a follow-up study of 63 patients treated with antimicrobial agents.

BEFORE antimicrobial therapy miliary tuberculosis was usually a fatal complication of primary tuberculosis. Cases of spontaneous recovery have been reported in children. Wallgren1 described 5 recov...

Should primary tuberculosis in childrencontinue to be neglected

Summary Primary tuberculosis is the fountainhead of tuberculous diseases. When acquired during childhood, it may develop into serious tuberculous diseases within a short period of time, or it may remain latent during childhood only to become reactivated in adult life, giving rise to such condition as chronic pulmonary tuberculosis. Until recently, little could be done to control the natural consequences of primary tuberculosis. As a result, large numbers of infected children and adults continue to fall ill with tuberculosis. The discovery of isoniazid had opened a new hope. Animal experiments have brought forth convincing evidences that isoniazid is effective in controlling primary tuberculosis, even in its progressive form. Clinical experiences strongly indicate that serious tuberculous diseases can be prevented in infected children by the early institution of isoniazid therapy. Since its use three years ago, there has been a sharp decline in the incidence of tuberculous meningitis and miliary tuberculosis in children. Now that primary tuberculosis canbe treated, it is more than ever a regret that a child be allowed to develop serious tuberculous diseases. Pediatricians and public health officers must assume their new responsibility of recognizing primary tuberculosis and make available to infected children the benefit of modern drug therapy. There is no other means which can detect primary tuberculosis as early and as accurately as a simple tuberculin test. For this reason, tuberculin testing must be made a routine pediatric procedure in well-baby clinics, nurseries, and schools, as well as in children's clinics and in private practice. One of the greatest pediatric triumphs in the United States is the conquer of congenital syphilis in the current generation. This was accomplished by public education, universal serologic tests and vigorous drug therapy of the syphilitic pregnant mothers. Today the principle of tuberculosis control should be universal tuberculin testing and vigorous drug therapy of tuberculosis in children and adults. There is yet much to be learned about primary tuberculosis and isoniazid therapy. Most likely, newer and better drugs will be discovered. From now on a large share of the responsibility of tuberculosis control will fall on the shoulders of pediatricians. Primary tuberculosis can no longer be neglected.

Isoniazid in the treatment of miliary tuberculosis in children.

<h3>Background</h3> Medication errors commonly occur at transition points in patient care, particularly on admission to hospital. Medicines reconciliation is the process of identifying the most accurate list of a patient’s current medicines and it should be done before the first 24 hour after admission. The participation of pharmacists in obtaining an accurate medication history for hospitalised patients is a key point in improving the process of reconciliation. <h3>Purpose</h3> Evaluate the benefits of the introduction of a pharmacist into the Emergency Department (ED) to improve the reconciliation process. <h3>Material and methods</h3> A prospective intervention study (2016–2017). The medication was reconciled at two different times and places: in admission to the geriatric ward (2016) and the admission to the ED (2017). Patients older than 65 years and six or more drugs admitted to the ward were included. A target was set that ideally 100% of patients admitted would have their medications reconciled within 24 hour of admission. To calculate the percentage of patients reconciled within 24 hour, the total number of patients who met the inclusion criteria for conciliation were collected. We did not collect data on Saturdays or Sundays. For the inferential statistics, the Chi-square test was used. <h3>Results</h3> A total of 394 patients was reconciled, 106 patients in the ward for the first time and 288 patients in the ED for a second time. The percentage of patients with their medicines reconciled by a pharmacist within 24 hour of admission increased from 38% in the ward to 83% in the ED, and was significant (p&lt;0.001). The lack of weekend cover resulted in not meeting the target of 100% of patients having medication reconciliation complete within 24 hour of admission. For those patients in the ED who had been admitted medically but awaited a bed on a ward for a number of hours, the opportunity for their medicines to be reconciled within 24 hour was greatly reduced in the absence of an ED pharmacist. <h3>Conclusion</h3> The presence of an ED pharmacist improves the number of patients who have their medicines reconciled within 24 hour of admission. Since this initial project, we must continue working to expand the role of the clinical pharmacist further and to provide an extended pharmacy service to both hospital staff and patients. <h3>References and/or acknowledgements</h3> No conflict of interest.

Hepatomegalic liver in children with chronic miliary tuberculosis and liver biopsy findings; studies upon the nutrition of children in Hirosaki area. 11th Report.

1. In Hirosaki Area infantile pellagra or nutritional dystrophy has been prevalent.2. Marked enlargement of the liver as a prominent feature among clinical manifestations of chronic miliary tuberculosis in children in this Area should be regarded in a new light.3. Liver biopsy was carried out in 2 cases of chronic miliary tuberculosis, and it revealed miliary tubercles, portal fibrosis and marked fatty infiltration of the organ.4. Marked enlargement of the liver in these tuberculous children will be ascribed to fatty infiltration of the liver (identified by liver biopsy) probably due to dietary deficiency prior to their tuberculous infection.

The prognosis of chronic miliary tuberculosis in children

Twenty-one cases of chronic miliary tuberculosis in children are analysed with regard to the course of their lung lesions, the course of their disease and the incidence among them of other tuberculous conditions. Assessment of the prognosis for such cases should be divided into two parts: (1) the immediate prognosis, depending on recovery from the initial miliary spread into the lungs, the chances of which are approximately inversely proportional to the degree of tox˦mia; (2) The late prognosis, depending upon the development of further tuberculous lesions. It is suggested that the late prognosis depends mainly on the healing of the bloodstream focus and that this focus is often a caseating, paratracheal gland.

Chronic miliary tuberculosis in children

Chronic miliary tuberculosis in children

SUBACUTE MILIARY TUBERCULOSIS

While the literature on acute miliary tuberculosis in children in the United States is extensive, the reports on the subacute and chronic forms are rather meager. Greengard reported fifty-four cases of miliary tuberculosis in children from the Cook County Hospital in 1925, all of them fatal, only 9 per cent of the children surviving from three to four months. The pathologic explanation for the almost invariable fatality of miliary tuberculosis is as follows: At successive times, there occur discharges of tubercle bacilli into the blood stream from some primary focus, usually a lymph node. This is borne out by the resultant crops of tubercles, the tubercles of each crop being of approximately the same size. Successively repeated discharges of tubercle bacilli into the blood stream are almost invariably the rule, which accounts for the generalized infection that rapidly overwhelms the organism. It is conceivable that if the primary focus is