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1. AZERBAIJAN
MEDICAL
UNIVERSITY
 NAME: ZAKARYA KAMAL SATTOUF
 GROUP: 180B
 SUBJECT: MILIARY TUBERCULOSIS
 DATE; 12/7/2019
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2.  INTRODUCTION
 Definition
 History
 Risk factors
 Types and forms
 Pathophysiology of miliary TB
 Clinical findings
 Diagnosis
 Differentiation
 Treatment
 Complication
 prevention
 References
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3.  DEFINITION
 Miliary TB is an a form of disseminated TB
or Extra pulmonary TB that is caused by
sudden diffuse dissemination of tubercli
bacili through the bloodstream (
hematogenous spread of TB )
 The foci are possible caseous - necrotic
changes. Focal changes develop in the
interstitial tissues
 In miliary TB foci formed small ( 1-2 mm )
with productive tissue reaction
 Small foci look like millet grains
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4.  Miliary Tuberculosis: mainly occurs in
children and young adults but may also
occur in older people and it is insidious in
onset in this older age group
 Miliary TB : is can be difficult to diagnose
especially in older age group in which case
it is known as Cryptic Tuberculosis (because
of its insidious onset

5.  HISTORY
 Miliary TB got its name in 1700 from John Jacob
Manget based on how it appears on autopsy
findings.
 The bodies would have a lot of very small spots
similar to hundreds of tiny seeds about
 2 millimeters long scatted in various tissues.
 Since a millet seed is about that size,
 the condition became known as miliary TB

6.  Small foci like millet seed which is
scatted in various tissues

7.  RISK FACTORS
• Age – Child & Elderly
• Immunosuppression
• Cancer
• Transplantation
• HIV
• Malnutrition
• Diabetes
• Silicosis
• End-stage renal disease
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8. The miliary TB can be develop in the
1. Miliary pulmonary tuberculosis: occurs when the
organisms draining through the lymphatic and
pulmonary arterioles and enter to the venous blood
and circulate back to the lung
2. Systemic miliary tuberculosis ; occurs when bacteria
disseminate through the systemic arterial system.
 TYPES

9. MILIARY TB
SEPSIS
POLMONARY TYPHOIDAL
MENINGITIC
 THE MAIN CLINICAL FORMS
OF MILIARY TB

10.  PATHOPHYSIOLOGY OF
MILIARY TB
• Tuberculosis infection in the lungs results in
erosion of the epithelial layer of alveolar cells
and the spread of infection into a pulmonary vein
• Bacteria reach the left side of the heart and
enter the systemic circulation, they may multiply
and infect extra pulmonary organs
• Once infected, the cell mediated immune
response is activated. The infected sites become
surrounded by macrophages which form
granuloma, giving the typical appearance of
miliary tuberculosis
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12.  CLINICAL FINDINGS
• Patients may not be acutely ill
• Symptoms include
• Weakness and fatigue (90%)
• Fever and weight loss (80%)
• Chills, night sweats are common
• Cough,
• Hemoptysis
• Anorexia
• Hepatomegaly and lymphadenopathy are
common
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13.  DIAGNOSIS
• CBC
- Leukopenia/leukocytosis
• ESR - elevated in approximately 50% of
patients
• Lumbar puncture - strongly considered
 Lymphocytic predominance (70%)
 Elevated protein levels (90%)
 Low glucose levels (90%)
 Acid-fast bacilli (≥40%)
• Cultures for mycobacteria
• PCR
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14. • Typical appearance only in 50% of cases
• Bilateral pleural effusions indicate
dissemination. This may be a useful clue.
• Nodules characteristic of miliary TB may
be better visualized on lateral chest
radiography (especially in the retro cardiac
space).
• Nodules are the size of millet seeds
(1-5mm, mean=2mm)
 CHEST X-RAY
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16. CT SCAN

18. • The typhus begins with
gradually developing of
weakness and increase of
temperature
• Bradycardia
 leucopenia
 lymphocytosis
• Widal’s reaction can be
positive just in typhus
• Breathlessness
• Cyanosis
• Tachycardia
• irregular type fever
• absence of dyspeptic
disturbances
 leucocytes within the limits of
norm or leucocytosis up to
15 000-18 000
 lymphopenia
 Monocytosis
• Roentgenograms confirm
suspicions on miliary lung
tuberculosis
 MILIARY
TUBERCULOSIS
 ABDOMINAL
TYPHUS
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19. • Four-drug regimen to start
 Isoniazid
 Rifampin
 Pyrazinamide
 Ethambutol or streptomycin
• Treatment may continue for 6-9 months
• 9-12 months with meningeal involvement
 TREATMENT
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20. • Dissemination via bloodstream to
I. Prostate
II. Seminal vesicles
III. Epididymis
IV. Fallopian tubes
V. Endometrium
VI. Meninges
VII.Lymph nodes
VIII.Liver
IX. Spleen
X. Skeleton
XI. Kidneys
XII.Adrenals
COMPLICATIONS
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22. BCG vaccination
 Effective in reducing the incidence of miliary
tuberculosis Not effective in individuals who are
already infected
 Should not be administered to
immunosuppressed hosts
 Targeted tuberculin testing
 Treatment of latent tuberculosis infection
 PREVENTION

23. REFERENCES:
https://www.slideshare.net/chaudharymahesh/miliary-
tuberculosis-dr-mahesh
http://tuberkulez-forever.com/tuberkulez-likbez/eng
https://www.slideshare.net/DeepakKumarGupta2/granulomatous
-inflammation-tuberculosis-syphillis
https://www.slideshare.net/ghalan/pulmonary-tuberculosis-
2941528
https://slideplayer.com/slide/10787857/
https://en.wikipedia.org/wiki/Jean-Jacques_Manget
https://www.slideshare.net/chaudharymahesh/miliary-
tuberculosis-dr-mahesh
https://www.youtube.com/watch?v=9HUmsnp-nYg
https://www.healthline.com/health/miliary-tuberculosis
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