title: Challenges in the diagnosis & treatment of miliary tuberculosis.
abstract: Miliary tuberculosis (TB) is a potentially lethal disease if not diagnosed and treated early. Diagnosing miliary TB can be a challenge that can perplex even the most experienced clinicians. Clinical manifestations are nonspecific, typical chest radiograph findings may not be evident till late in the disease, high resolution computed tomography (HRCT) shows randomly distributed miliary nodules and is relatively more sensitive. Ultrasonography, CT and magnetic resonance imaging (MRI) are useful in discerning the extent of organ involvement by lesions of miliary TB in extra-pulmonary locations. Fundus examination for choroid tubercles, histopathological examination of tissue biopsy specimens, conventional and rapid culture methods for isolation of Mycobacterium tuberculosis, drug-susceptibility testing, along with use of molecular biology tools in sputum, body fluids, other body tissues are useful in confirming the diagnosis. Although several prognostic markers have been described which predict mortality, yet untreated miliary TB has a fatal outcome within one year. A high index of clinical suspicion and early diagnosis and timely institution of anti-tuberculosis treatment can be life-saving. Response to first-line anti-tuberculosis drugs is good but drug-induced hepatotoxicity and drug-drug interactions in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients pose significant problems during treatment. However, sparse data are available from randomized controlled trials to define the optimum regimen and duration of treatment in patients with drug-sensitive as well as drug-resistant miliary TB, including those with HIV/AIDS.
authors: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. sksharma.aiims@gmail.com
authors: Surendra K
authors: SK
authors: Sharma
authors: Alladi
authors: A
authors: Mohan
authors: Abhishek
authors: A
authors: Sharma
mesh_terms: D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007165:Immunosuppression Therapy; D008279:Magnetic Resonance Imaging; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification* / Q000472:pathogenicity; D014391:Tuberculosis, Miliary / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D014463:Ultrasonography / Q000379:methods
chemical_list: D000995:Antitubercular Agents