Disseminated tuberculosis with and without a miliary pattern on chest radiograph: a clinical-pathologic-radiologic correlation.
METHODS
Province of Manitoba, Canada.


OBJECTIVE
To describe the characteristics of disseminated tuberculosis (TBD) with and without a miliary pattern on chest radiograph, to determine the mortality, and to identify the demographic and clinical features associated with survival.


METHODS
A retrospective case review.


RESULTS
Of 2013 cases of active tuberculosis reported to the Provincial Tuberculosis Registry between January 1979 and December 1993, 56 had disseminated disease. The odds of developing TBD were significantly higher in females. Compared to those with a miliary pattern (n = 42), those without a miliary pattern on chest radiograph (n = 14) were significantly more likely to have a risk factor for tuberculosis (86% vs 52%, P < 0.05) and to die (86% vs 21%, P < 0.001). The diagnosis of TBD was significantly more likely to be made at postmortem in non-miliary compared to miliary patients (43% vs 5%, P < 0.05). Amongst patients with a miliary pattern, the presence of one or more risk factors for tuberculosis was associated with a significantly higher mortality (P < 0.05). Meningitis was very uncommon and did not determine the outcome.


CONCLUSIONS
Disseminated tuberculosis patients without a miliary pattern on chest radiograph have an extremely high mortality rate; those with a miliary pattern may also succumb, especially if co-morbid with a condition known to increase the risk of tuberculosis.
Long
R
R
Department of Medicine, University of Manitoba, Winnipeg, Canada.
O'Connor
R
R
Palayew
M
M
Hershfield
E
E
Manfreda
J
J
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001706:Biopsy; D001826:Body Fluids / Q000166:cytology / Q000382:microbiology; D001853:Bone Marrow / Q000473:pathology; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D017678:Sex Distribution; D015996:Survival Rate; D014391:Tuberculosis, Miliary / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000401:mortality / Q000473:pathology