Tuberculosis Study Guide - M.M. Savula 2002

Disseminated pulmonary tuberculosis
Acute disseminated pulmonary tuberculosis. Miliary tuberculosis

This form is rare, occurring in immunocompromised individuals, the elderly, sometimes in women during Pregnancy and the postpartum period, and occasionally in children living in tuberculosis foci under poor sanitary and living conditions. Multiple small foci the size of a millet seed (milia - millet) form in the Lungs and often in other Organs (Liver, Kidneys, etc.). In these cases, generalized Miliary tuberculosis develops.

Clinical presentation. Miliary tuberculosis has an acute onset, with high body Temperature reaching 39-40 °C, chills, headache, and general malaise. In the first days of the illness, there are no symptoms of bronchopulmonary involvement, so these patients are often hospitalized in infectious disease departments. Recently, cases have been observed where the acute phase of the disease is preceded by prodromal symptoms, such as general weakness and intermittent low-grade fever.

In the first days of the disease, there are no Percussion or auscultatory changes over the lungs, which complicates Diagnosis. Subsequently, the general symptoms of intoxication are accompanied by a dry cough, dyspnea (sometimes reaching 40 breaths per minute), and cyanosis of the Lips. A slightly enlarged liver and sometimes Spleen are palpable. Harsh breath sounds and occasional dry or fine moist crackles (rales) are detected over the lungs. In the peripheral Blood, the WHITE BLOOD Cell count is normal or slightly elevated, with a mild left shift of the leukocytic formula, significant lymphopenia, and a normal or slightly elevated ESR. The Mantoux test is positive, but as the patient's condition worsens, it becomes negative. Mycobacterium tuberculosis is rarely found in the sputum.

Chest radiography plays a crucial role in establishing the diagnosis. However, Changes in the form of small, uniform foci scattered evenly throughout all lung fields are detected on the radiograph only on the 7-10 day of the illness.

Depending on the predominance of certain symptoms, typhoid, pulmonary, and meningeal forms of miliary tuberculosis are distinguished. When a patient develops a severe headache and vomiting, and a rapid pulse is replaced by relative bradycardia, the onset of Tuberculous meningitis (meningeal form) must be suspected.

Miliary tuberculosis is a progressive form of tuberculosis, and without Treatment, patients die within 30-40 days from the onset of the disease. However, if the diagnosis is made in a timely manner and specific treatment is prescribed, complete recovery occurs, which is why timely diagnosis is so critical.