Miliary Tuberculosis Patients Research Articles

Pneumothorax occuring during the final stage of treatment in miliary tuberculosis patients

Air in the pleural space can cause lung collapse and respiratory discomfort, which can be life-threatening in very ill patients, making pneumothorax a medical emergency. Since tubercle bacilli can travel through the blood to the lungs and other organs, Miliary Tuberculosis (TB) is a disseminated disease that can be lethal. We present a case of a 36-year-old male with Pneumothorax Occuring during the Final Stage of Treatment in Million Tuberculosis Patients. The patient is currently undergoing outpatient treatment of miliary TB for the 11th month and so far his condition is getting better, however was admitted to the emergency unit of the hospital, diagnosed with left pneumothorax based on clinical, laboratory, and radiology showing. In meanwhile, 88% of the room air was saturated with oxygen, necessitating Intensive Care Unit treatment with HFNC FiO2 100 Flow 60, followed by high consentration oxygen therapy with a non-rebreathing mask (NRM) of 15 litres/minute. Combivent inhalation and pulmicort inhalation were given every 15 minutes. The family refused to install a water sealed drainage or chest tube in the patient. The patient was also given treatments with ceftriaxone, citicolin, methylprednisolone, omeprazole and the advanced phase of tuberculosis drugs namely Rifampicin 450 mg and Isoniazid 300 mg. On the 6th day of treatment in the ICU, the patient's condition improved and the pneumothorax decreased. In this case, the likelihood of Pneumothorax in patients with miliary tuberculosis needs to be emphasized, as well as the importance of evaluation and strict follow-up to prevent the occurrence of pneumothorax.

Extremely high levels of central nervous system involvement in miliary tuberculosis

BackgroundMiliary tuberculosis (TB) is one of the severest manifestations of TB that can be lethal when concomitant with the central nervous system (CNS) involvement. Bacteriological, biochemical and radiological methods for find CNS comorbidity in miliary TB was evaluated in this study.MethodsConsecutive miliary TB adults were retrospectively enrolled from two designated TB hospitals in China. The capacities of examinations of cerebrospinal fluid (CSF), cerebral computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis of CNS involvement were assessed.ResultsAssessment of CNS involvement with a lumbar puncture and/or neuroimaging was undertaken in 282 out of 392 of acute miliary TB. Of these 282 patients, 87.59% (247/282) had CNS involvement. Cerebral contrast-enhanced MRI (96.05%, 170/177) and MRI (93.15%, 204/219) yielded significantly higher sensitivities over CSF examination (71.92%, 146/203, P < 0.001) and CT (34.69%, 17/49, P < 0.001). The sensitivity of CSF examination was superior to CT scan (P < 0.001). Although 59.65% (134/225) miliary TB patients acquired bacteriological evidence with sputum examination, the positivity was only 8.82% (21/238) for CSF examination by conventional and molecular tests.ConclusionAlmost all miliary TB had CNS involvement and MRI demonstrated outstanding potential over other methods. Therefore, a routinely screening of CNS TB should be strongly suggested in miliary TB and MRI could be used as the initial approach in resources rich settings.

Presepsin as a novel diagnostic biomarker for differentiating active pulmonary tuberculosis from bacterial community acquired pneumonia

BackgroundThe expression of presepsin in active pulmonary tuberculosis (APTB) is unknown. We observed the expression of presepsin in APTB, and to evaluate the value for discriminating between APTB and bacterial community acquired pneumonia (BCAP). MethodsConsecutive APTB patients who were accurately diagnosed by sputum culture and BCAP patients were enrolled from August 2013 to July 2015. Clinical data were collected, and plasma presepsin concentrations were tested. Receiver operating characteristic (ROC) curves were performed for diagnostic analysis. ResultsIn all, 133 healthy individuals, 103 APTB and 202 BCAP patients were enrolled. Presepsin concentrations in APTB group (218.0 [146.0, 368.0] pg/ml) were higher than those in the healthy control group (128.0 [101.5, 176.5] pg/ml, P<0.001), and lower than the concentrations measured in the BCAP group (532.0 [364.0, 852.3] pg/ml, P<0.001). Simple APTB and miliary tuberculosis patients showed no significant differences in presepsin concentrations. Compared with both Gram-positive and negative bacteria, Mycobacterium tuberculosis caused a limited increase of presepsin. With the cut-off value set at 401pg/ml, presepsin demonstrated high positive predictive value, allowing initial discriminating between APTB and BCAP. Presepsin combined with CURB-65 score could significantly improve the discrimination ability. ConclusionsPresepsin concentrations in APTB patients were slightly increased, and may be helpful for initial discrimination between APTB and BCAP.

Clinical Analysis of Miliary Tuberculosis Patients in Our Tertiary Hospital

Objective: To investigate the clinical characteristics of miliary tuberculosis experienced in our tertiary hospital without a tuberculosis isolation room. Materials and Methods: We obtained a definite diagnosis of tuberculosis for 72 patients in our tertiary hospital between January 2010 and September 2016. There were six patients (8.3%) who were diagnosed with miliary tuberculosis following the isolation of Mycobacterium tuberculosis from several organs, and we analyzed the clinical findings. Results: The average age of the six patients with miliary tuberculosis was 74 years old (3 males and 3 females). All patients had underlying diseases and immunosuppressive treatment was performed for three patients. The detection methods were based on clinical symptoms such as high fever in all patients. Concerning the laboratory findings, three patients showed a negative or indeterminate response for interferon-gamma release assays (IGRAs). Bronchoscopic examinations were performed for five of six patients soon after admission and a definite diagnosis was obtained. Although treatment according to the American Thoracic Society (ATS) guidelines was performed for all patients, three of the six died due to complications or worsening of miliary tuberculosis. Conclusions: Patients with miliary tuberculosis experienced in a tertiary hospital were frequently detected among patients receiving immunosuppressive treatment for a long time. Because these patients showed a rapid progressive clinical course, it is thought to be important to perform bronchoscopic examination proactively for patients suspected of miliary tuberculosis on radiological findings to make an appropriate early diagnosis and start treatment.

M39 Screening For Tuberculomas In Patients With Miliary Tuberculosis - What Modality Of Imaging Should We Be Using?

Introduction and objectives NICE guidance advises neuroradiology to investigate CNS signs in patients with miliary tuberculosis (TB). The aims of our study were to describe our population of patients with tuberculomas in the presence of miliary disease and identify any clues to the best radiological modality. Methods The radiology and clinical history was retrospectively reviewed for all patients treated for miliary tuberculosis at one centre between 01/01/2009 and 31/12/2013. Results 53/1650 (3.2%) of patients during this period were diagnosed with miliary (disseminated) tuberculosis. 27/53 (50.9%) underwent further neuroimaging. 10/53 (18.9%) miliary TB patients had evidence of tuberculomas on neuroimaging (M:F 6:4, age range 22:81). 2/10 had evidence of tuberculomas on both CT (2/2 with contrast) and MRI, 5/10 had a negative CT (2/5 with contrast) but an MRI result which revealed tuberculomas. 3 patients did not have a CT scan (MRI only). All 10 patients were HIV negative and had fully sensitive TB, 9/10 had neurological signs which warranted the subsequent neuroimaging. Conclusion Tuberculomas are seen in a fifth of patients with miliary tuberculosis. Based on our findings, guidelines should be adapted to suggest that both use of contrast and MRI should be utilised preferentially.

Clinical relevance of ground glass opacity in 105 patients with miliary tuberculosis

After the application of chest computed tomography (CT), ground glass opacity (GGO) was introduced as one of major accompanying findings of miliary tuberculosis (MT) in addition to miliary nodules. However, little is known about whether GGO is associated with the clinical manifestations and outcomes of MT. Therefore, the present study examined the clinical relevance of GGO in patients with MT. Chest radiographs and CT scans of MT patients were retrospectively reviewed. Clinical manifestations and outcomes were compared in terms of the extent of GGO revealed by chest CT. Confirmed 105 MT patients were included. GGO was observed in 70 (67%) patients. MT patients with an extent of GGO >50% (n = 21) had symptoms of shorter duration, more frequent dyspnea, and more pronounced changes in the levels of acute phase reactants. Miliary nodules were less discernible on CT in those with an extent of GGO >50%. MT patients with an extent of GGO >50% were significantly associated with a longer hospital stay (p = 0.02) and with acute respiratory failure (p < 0.001) than those with an extent of GGO ≤ 50%. However, mortality among MT patients was not associated with the extent of GGO. MT patients with an extent of GGO >50% had more rapidly progressive manifestations and a greater potential for delayed diagnosis and poorer prognosis. Nevertheless, mortality was not higher in confirmed MT patients with an extent of GGO >50% than in those with an extent of GGO ≤ 50%.

Diagnosis of isolated pancreatic tuberculosis: the role of EUS-guided FNA cytology

m A g t c b s r e e t ( t About 12.5% of all patients with tuberculosis (TB) have extrapulmonary disease. Abdominal TB accounts for 11% to 16% of patients with extrapulmonary TB. Abdominal B commonly affects the liver, spleen, and ileocecal reion. Pancreatic and/or peripancreatic involvement of TB s very rare, even in areas where TB is endemic.2-4 Isolated pancreatic tuberculosis is an extremely rare entity. Bhansali,5 in a series of 300 miliary tuberculosis patients over 12 years in India, did not reveal even 1 with pancreatic involvement. This is probably because of the antibacterial effect of the pancreatic enzymes.6 The pandemic of IV infection has led to increased incidence of tuberculois. Increased use of immunosuppressants also contributes o increased occurrence of TB.7-10 Autopsy series of patients with miliary TB showed pancreatic/peripancreatic involvement in only 2.1% to 4.7%.11,12 Tubercular involveent of the pancreas occurs as a result of contiguous pread from adjacent organs or lymph nodes, lymphoheatogenous dissemination, and reactivation of a previous ormant focus or immune reaction to generalized tuberulosis.13,14 The pancreas may be directly involved with eripancreatic or periportal tubercular lymphadenitis.15 Pancreatic TB can present as a cystic or solid pancreatic mass that mimics pancreatic cancer, which makes it difficult to differentiate these two conditions.15,16 A correct diagnosis is crucial for proper treatment and to avoid

Differential Cell Analysis and Lymphocyte Subset Analysis in Bronchoalveolar Lavage Fluid from Patients with Miliary Tuberculosis

Background: Bronchoalveolar lavage (BAL) is a useful technique to recover lower airway fluid and cells involved in many respiratory diseases. Miliary tuberculosis is potentially lethal, but the clinical manifestations are nonspecific and typical radiologic findings may not be seen until late in the course of disease. In addition, invasive procedures are often needed to confirm disease diagnosis. This study analyzed the cells and the T-lymphocyte subset in BAL fluid from patients with miliary tuberculosis to determine specific characteristics of BAL fluid that may help in the diagnosis of miliary tuberculosis, using a less invasive procedure. Methods: On a retrospective basis, we enrolled 20 miliary tuberculosis patients; 12 patients were male and the mean patient age was years. We analyzed differential cell counts of BAL fluid and the T-lymphocyte subset of BAL fluid. Results: Total cells and lymphocytes were increased in number in the BAL fluid. The percentage of CD4+ Tlymphocytes and the CD4/CD8 ratio in BAL fluid were significantly decreased and the percentage of CD8+ T-lymphocytes was relatively higher. These findings were more prominent in patients infected with the human immunodeficiency virus (HIV). In the HIV-infected patients, the proportion of lymphocytes was significantly higher in BAL fluid than in peripheral blood. There were no significant differences between the BAL fluid and the peripheral blood T-lymphocytes subpopulation. Conclusion: BAL fluid in patients with miliary tuberculosis demonstrated lymphocytosis, a lower percentage of CD4+ T-lymphocytes, a higher percentage of CD8+ T-lymphocytes, and a decreased CD4/CD8 ratio. These findings were more significant in HIV-infected subjects.

Neurological complications of miliary tuberculosis

Introduction The symptomatic central nervous system involvement is often seen in patients with miliary tuberculosis. Materials and methods In this study, we evaluated 60 consecutive miliary tuberculosis patients, who presented with some neurological manifestations. Evaluation included neurological examination, a battery of blood tests, HIV serology, sputum examination, cerebrospinal fluid (CSF) examination along with imaging of the brain and spinal cord. The patients were followed up after completion of 6 months of antituberculous treatment. Results Patients ranged between 14 and 53 years in age. Three patients tested HIV positive. Forty-eight (80%) patients had tuberculous meningitis. In 12 (20%) patients, the CSF examination was normal. In 27 patients with tuberculous meningitis, neuroimaging revealed intracerebral tuberculoma. Fourteen patients showed multiple tuberculomas, while 7 had a solitary tuberculoma. In six patients, the tuberculomas were small and numerous. In two patients, neuroimaging revealed a spinal tuberculoma. For three patients with tuberculous brain masses, the CSF was normal. Nine (15%) patients presented with myelopathy. Three patients exhibited Pott's paraplegia. Three patients had transverse myelitis (with normal neuroimaging). In three patients, the spinal MRI revealed an intramedullary tuberculoma. On follow-up, 15 (25%) patients expired. Thirty-one (52%) patients showed significant improvement. Eight patients (13%) showed nil or partial recovery. Six of the patients with no improvement developed vision loss. Six (10%) patients were lost to follow up. Conclusion A variety of neurological complications were noted in military tuberculosis patients, tuberculous meningitis and cerebral tuberculomas being the most frequent complications. However, a majority of patients improved following antituberculous treatment.

Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis

The effects of malnutrition on outcomes in miliary tuberculosis (MTB) are not well described. The aim of the present study was to find predictors for the development of acute respiratory failure (ARF) and survival in MTB patients, focusing on parameters reflecting nutritional condition. Out of the patients from three hospitals who had microbiologically or histopathologically confirmed tuberculosis, 56 patients presenting with typical disseminated pulmonary nodules on radiographs were retrospectively enrolled. A four-point nutritional risk score (NRS) was defined according to the presence of four nutritional factors: low body mass index (BMI; <18.5 kg x m(-2)), hypoalbuminaemia (<30.0 g x L(-1)), hypocholesterolaemia (<2.33 mmol x L(-1)) and severe lymphocytopenia (<7 x 10(5) cells x L(-1)). The male to female ratio was 1:3. ARF developed in 25% of patients (14 out of 56), with a 50% fatality rate. A high NRS (> or =3 points) was an independent risk factor for the development of ARF and fatality. In 90-day survival analysis, ARF, severe lymphocytopenia, hypocholesterolaemia, low BMI and higher NRS were risk factors for poor outcome. In multivariate analysis, only high NRS was an independent risk factor for 90-day survival rate in patients with MTB. A high nutritional risk score was a good predictor of poor outcome in miliary tuberculosis patients. Additional approaches to recover the nutritional deficits may become a focus in future management of miliary tuberculosis.

A COMPARATIVE REVIEW OF PEDIATRIC AND ADULT PATIENTS WITH MILIARY TUBERCULOSIS

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.

当院における粟粒結核の臨床的検討

Eighteen patients with miliary tuberculosis (MTB) were admitted to our hospital from 1994 to 2003. The mean age of the patients was 63.9 years (range 19-92). Past history of tuberculosis was recognized in one case. Six cases suffered from another underlying diseases, and 3 of them had been treated with corticosteroids. Smear, PCR and culture of sputum were positive for mycobacterium tuberculosis in 61%, 79% and 94% of cases, respectively. Chest computed tomography revealed diffuse micronodular shadow and diffuse infiltration in 100% and 22% of cases, respectively. The laboratory findings of 18 patients with MTB were compared with 240 patients with non-MTB who were admitted to our hospital from 1999 to 2001. Body mass index, serum total protein, albumin and peripheral blood lymphocyte count were significantly lower in MTB patients than in non-MTB patients. Five patients died during admission, 3 of them died of MTB and 2 of them died of cardiac disease. In the 3 died patients due to MTB, 2 of them had been treated with corticosteroids for fever, 2 of them had acute respiratory distress syndrome and 3 of them had disseminated intravascular coagulation. Serum total protein, albumin and platelet count were lower in the died patients due to MTB than in the living patients.

Radiographic Findings of Miliary Tuberculosis: Difference in Patients with and those without Associated Acute Respiratory Failure

Purpose: To determine the differences in the radiographic findings of miliary tuberculosis between patients with and without associated acute respiratory failure (ARF). Materials and Methods: We retrospectively reviewed 32 patients in whom miliary tuberculosis had been diagnosed, and assigned them to one of two groups: with ARF (n=10), and without ARF (n=22). Chest radiographic findings such as the presence of miliary nodules, cosolidation, ground-glass opacity (GGO), pleural effusion, small calcified nodules and linear opacities were assessed, the size and profusion of nodules in each of four zones were analyzed and scored using the standard radiographs of the International Labor Organization, and the extent of consolidation and GGO were scored according to the percentage of involved lung. We compared the radiologic findings between the two groups. Results: Ground-glass opacity, consolidation, and pleural effusion were seen more frequently in miliary tuberculosis patients with ARF than in those without ARF. Although the size and profusion of nodules were similar in both groups (p>0.05), consolidation and ground-glass opacity in cases of miliary tuberculosis with ARF were significantly more extensive than in those without ARF (p

HIV seroprevalence in patients with tuberculosis

The number of patients co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB) in our hospital is increasing year after year. Although most patients were HIV tested because of miliary tuberculosis or extra-pulmonary tuberculosis, some patients were found HIV seropositive by chance. In order to determine the incidence of HIV seropositivity among TB patients, HIV testing was carried out in TB patients for two years from January 1998 with the consent of patients. TB patients who received anti-HIV antibody examination were 164 in 1998, and 149 in 1999 and among them HIV seropositive TB patients were 4 in 1998 and 6 in 1999. The incidence of HIV seropositivity was 3.2% in all TB patients, 28.6% in miliary TB patients, and 1.0% in typical TB patients. The number of patients co-infected with HIV and TB in Tokyo was estimated by using these HIV seropositivity, it was 23 cases/year among miliary TB patients and 16 cases/year among typical TB patients. As there were many HIV-infected persons and many TB patients in Tokyo, it was thought that HIV testing in TB patients was important for the early detection of HIV infection and the early initiation of HIV treatment.

Hematologic Studies of Peripheral Blood and Bone Marrow in Miliary Tuberculosis

BACKGROUND: Tuberculosis has commonly been associated with various hematologic changes. A difference between the changes found in pulmonary tuberculosis and those found in miliary tuberculosis has been discussed. Up to now some worker were investigated hematological changes associated with pulmonary tuberculosis but was not investigated those associated with miliary tuberculosis in korea. Therefore we examimed the peripheral blood and bone marrow findings in miliary tuberculosis patients to determine hematologic changes. METHODS: We performed blood sample at admission and bone marrow biopsy within 7days after admission. For evaluation of the hematologic findings, full blood counts and marrow differential counts were defined by the criteria outlined by Dacie and Lewis2). RESULTS: 1) Peripheral blood findings: Pancytopenia in 10% of patients, anemia in all patients, leukocytosis in 10% of patients, leukopenia in 20% of patients, thrombocytopenia in 30% of patients, lymphocytopenia in 90% of patients, monocytosis in 40% of patients and neutrophilia in 10% of patients were found at peripheral blood. 2) Bone marrow findings: Lymphocytopenia in 30% of patients, lymphocytosis in 20% of patients, plasmacytosis in 40% of patients, monocytosis in 100% of patients, and hypocellularity in 30% of patients were found at bone marrow. Erythropoiesis was decreased in 30% of patients. Granulopoiesis was decreased in 20% of patients and increased in 20% of patients. Bone morrow granuloma occured in 25% of patients. CONCLUSION: Hematologic changes of miliary tuberculosis were seen tendency of cytopenic pattern but monocyte was increased at peripheral blood and bone morrow. This findings would provide additional information for the differential diagnosis of miliary tuberculosis.

A study of tubercular antigen and antibody in childhood tuberculosis.

A radioimmunoassay for the detection of tubercular (TB) antigen (Ag) and antitubercular antibody (Ab) was evaluated for the serodiagnosis of childhood tuberculosis. Children with primary complex, progressive primary complex, miliary tuberculosis, and calcified lung lesions without clinical evidence of active tuberculosis were studied. Significantly elevated levels of TB Ag and TB Ab isolated from the circulating immune complexes were obtained in primary, progressive primary, and miliary tuberculosis patients as compared to controls (P less than 0.01). The majority of patients with calcified lung lesions and without active tuberculosis demonstrated high levels of antibody. It was observed that elevated levels of TB Ag and/or antibodies were present in 54 per cent of patients with primary complex, 94 per cent of patients with progressive disease and 69 per cent of patients with miliary tuberculosis. It is possible that is suspected patients with the above mentioned diseases, a diagnosis can be established by using these techniques.