This document discusses miliary tuberculosis. It begins with an introduction that defines miliary TB and outlines its history, risk factors, types, pathophysiology, clinical findings, diagnosis, treatment, and prevention. Miliary TB is a disseminated form of extra pulmonary TB caused by hematogenous spread of mycobacteria through the bloodstream. It most commonly appears as small, millet seed-sized lesions scattered throughout multiple organs. Symptoms can include weakness, fever, weight loss, and hepatomegaly. Diagnosis involves blood tests, lumbar puncture, cultures, and chest imaging. Treatment typically involves a multi-drug regimen over 6-9 months.

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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