Miliary Tuberculosis: Symptoms, Causes And Treatment
Have you ever heard of miliary tuberculosis? Are you interested in knowing everything about this disease? Keep reading and we will explain it to you.
Tuberculosis is a disease caused by a bacteria called Mycobacterium tuberculosis. This pathology has multiple forms of presentation and one of the least frequent is miliary tuberculosis. Do you want to know what its symptoms, causes and treatment are? We will clarify it for you below.
This type of presentation gets its name due to the formation of small circular lesions on the affected tissue, very similar to millet seeds. It occurs when the infection reaches a blood or lymphatic vessel and spreads in both lung fields, as well as other organs.
Symptoms of miliary tuberculosis
First it is important to clarify that being a disseminated infection it can affect any organ. Therefore, it does not usually have a specific symptomatology. Although the disease begins in the lungs, it affects the spleen, liver, meninges, and pericardium.
In this way, the symptoms may vary depending on each patient and the organs taken. However, being a long-standing infection, it is common to find the following symptoms:
- Fever of unknown origin.
- Involuntary weight loss
- Shaking chills.
- Muscle weakness and fatigue
- Shortness of breath or dyspnea.
- Cough with expectoration.
In addition, miliary tuberculosis is the most common extrapulmonary form of this disease, with an incidence of around 11%. In this way, when it reaches other organs, it can manifest itself through the following pathologies:
- Pyelonephritis: upon reaching the genitourinary system.
- Meningitis: when it takes the layers that cover the brain and spinal cord.
- Pericarditis: occurs when it affects the tissue that covers the heart.
- Peritonitis and lymphadenitis: the abdominal and pelvic lymph nodes are infected.
- Pott’s disease : when it is installed in the bone marrow of the vertebrae.
Causes of miliary tuberculosis
Before explaining the causes of this form of presentation, we must talk a little about the disease itself. This infection is characterized by having 2 phases: a primary and a post-primary or secondary.
In the primary phase, infection occurs for the first time and with proper treatment it can be resolved. However, when the immune system responds partially and the pathology is not fully cured, the bacteria will remain encapsulated in the body without causing damage.
Once the bacteria are encapsulated, if the patient is exposed again to the disease or some condition suppresses their immune system, it will reactivate causing post-primary or secondary tuberculosis. In this case, there is a dissemination that generates cavities or holes.
On the other hand, miliary tuberculosis occurs when the defense system does not respond adequately to infection. In this way, it can be generated from the primary or post-primary phase of the disease.
Although there are no specific causes of miliary tuberculosis, there are several predisposing factors. The main one is immunosuppression, especially from HIV and AIDS.
However, various conditions and pathologies can generate a failure in the immune system. Therefore, it is common to find this disease in the elderly, children under 4 years of age, malnourished, diabetics, chronic alcoholics and people with kidney failure or cancer.
Treatment of miliary tuberculosis
The treatment of miliary tuberculosis is complex and will depend on the degree of involvement of the patient. In general terms, there are 3 therapeutic options ranging from the use of antibiotics and corticosteroids to surgery.
Antibiotics
When it comes to antibiotic treatment of miliary tuberculosis, this does not differ much from that used in the classical pulmonary form. In this sense, a prolonged approach should be started that can last between 6 and 9 months. However, if the meninges are affected, it can last up to 12 months.
The protocol will include the use of those drugs that prevent bacterial proliferation and that destroy it. Thus, the doctor should recommend, in the first instance, the use of ethambutol, in addition to isoniazid, rifampicin, pyrazinamide and streptomycin.
Corticosteroids
The use of corticosteroids is not included in the routine treatment. It will only be recommended if there is a meningeal or pericardial affection. In such cases, mortality is reduced by 22% and 18%, respectively. On rare occasions, they can be used when the infection is very extensive.
Due to the large number of side effects that these have in the body, their use will not be prolonged. The treatment will last for 1 month and will be progressively withdrawn over 2 months.
Surgery
Surgery will not be a treatment for the infection itself, however it is used to resolve various complications of miliary tuberculosis. In this way, among the cases in which an intervention will be necessary, we have the following:
- Correct vertebral malformations.
- Drain an empyema, which is a collection of pus.
- Close fistulas, which are paths that carry pus to the outside.
- Eliminate some section of the intestine affected.
The risks of this disease
Miliary tuberculosis is a very dangerous disease that puts the life of those who suffer from it at risk. Despite being rare, it is important to be alert for any symptoms, especially if you have a predisposing factor for immunosuppression.
On the other hand, when it is diagnosed with this pathology, the most important thing is to follow the treatment strictly. This will be the only way to prevent antibiotic resistance and future complications.
