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Miliary tuberculosis: A new look at an old foe
Surendra K Sharma1, Alladi Mohan2, Animesh Sharma3
1Department of Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India.
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
|November 15, 2019
Summary
Miliary tuberculosis (TB) is a severe disseminated form of TB. Early suspicion, diagnosis via fundus examination and imaging, and prompt treatment are crucial for survival, especially with HIV/AIDS.
Area of Science:
- Infectious Diseases
- Pulmonology
- Global Health
Background:
- Miliary tuberculosis (TB) is a severe disseminated form of TB.
- Epidemiology is shifting due to the HIV/AIDS pandemic and immunosuppressive drug use.
- Protean manifestations necessitate a high index of suspicion for early diagnosis.
Purpose of the Study:
- To review the diagnostic approaches for miliary TB.
- To highlight the importance of early recognition and management.
- To discuss challenges and considerations in treating miliary TB.
Main Methods:
- Review of clinical presentation and diagnostic modalities.
- Emphasis on physical examination, funduscopy, and imaging.
- Discussion of microbiological and molecular diagnostic tests.
- Consideration of fluid analysis and tissue biopsies.
Main Results:
- Early diagnosis is aided by fundus examination (choroid tubercles) and imaging.
- Comprehensive microbiological testing (GeneXpert, cultures, DST) is essential.
- Prompt initiation of first-line anti-TB drugs yields good response.
- Monitoring for complications (ARDS, drug toxicity) and drug-drug interactions is vital.
Conclusions:
- Miliary TB requires a low threshold for suspicion and thorough investigation.
- Integrated diagnostic strategies improve early detection and management.
- Timely treatment and vigilant monitoring are key to improving outcomes in miliary TB.
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