Tb miliary: symptoms, causes, treatment & bull; hello healthy

Definition

What is TB Milier?

Milier tuberculosis (TB) is a type of tuberculosis (TB) that occurs due to the spread of bacteria Mycobacterium tuberculosis in large quantities to every organ of the body. Milier TB is one type of extra pulmonary TB, which is a condition when tuberculosis bacteria attacks organs other than the lungs.

This disease is characterized by the presence of small 1-5 mm nodules or spots on the infected organs.

The name miliary TB comes from the pattern seen on a chest X-ray with many tiny patches spreading across the lungs. The blotches look like millet seeds which gave rise to the term "milier". This type of TB can affect any organ, including the lungs, liver and lymph nodes.

How common is this disease?

This condition is found in 2% of reported cases of tuberculosis and is included in about 20% of all cases of diseases that attack organs outside the lungs. Milier TB can be overcome by controlling existing risk factors and stopping the bacterial infection that causes tuberculosis.

This disease can affect almost everyone. However, cases of occurrence are most often found in elderly people or children.

In addition, between 10% and 30% of adults and 20-40% of children with miliary TB also develop tuberculosis meningitis. This is caused by microbacteria that spread to the brain and space subarachnoid, causes tuberculosis meningitis.

Signs & symptoms

What are the signs and symptoms of miliary TB?

Patients with miliary TB often experience symptoms of tuberculosis that are nonspecific and difficult to distinguish from symptoms of other diseases, such as fever, fatigue, cough, loss of appetite and weight loss.

But as the disease progresses, it was mentioned in one study in the journal Clinical Tuberculosis and Other Mycobacterial Diseases, in the final stages of tuberculosis bacterial infection of the body organs in miliary TB can also cause the appearance of the following symptoms:

• Enlarged liver or hepatomegaly (enlargement of the liver)
• Inflammation of the pancreas
• Dysfunction of multiple organs with adreanal insufficiency (the adrenal glands do not produce enough steroid hormones to regulate organ function)
• Miliary TB can also sometimes be accompanied by pneumothorax (the size of the lung that is deflating)
• Stool texture can resemble diarrhea conditions

Other symptoms of miliary TB that can also appear include fever, hypercalcemia, tubercles chorodial and wounds on the skin.

Many patients may develop a fever that lasts for several weeks with a daily peak in the morning temperature.

Meanwhile, hypercalcemia is a condition when potassium levels in the blood are higher than normal levels. Hypercalcemia occurs in 16-51% of tuberculosis cases.

Hypercalcemia occurs in response to increased activity of macrophages (part of white blood cells) in the body by up to 1.25 dihydroxycholecalciferol (also known as calcitriol). Macrophages are white blood cells in the immune system that fight bacterial infections first.

This condition increases the ability of macrophages to kill bacteria, but levels calcitriol higher levels of calcium increase, leading to hypercalcemia in some cases.

While chorodial tubercules causes pale sores on the nerves of the eye, usually occurs frequently in cases of miliary TB in children with TB. These sores can appear in one or both eyes and the number of sores varies from patient to patient.

Although experts have known that tuberculosis bacteria spreads from the respiratory system to the bloodstream or lymphatic system (lymph vessels and lymph nodes) so that it attacks organs other than the lungs, the exact cause of this condition is not known.

One of the suspicions is that tuberculosis infection of the lungs results in damage to the outer lining of the alveoli cells (air sacs in the outermost part of the lung), which then results in the spread of bacteria through the blood vessels in the lungs.

The bacteria that enter the blood vessels in the lungs move towards the right side of the heart. From the right side of the heart, bacteria then infect the part of the lungs in near the heart. This condition is demonstrated by the typical appearance of miliary TB on chest X-ray.

The next movement of bacteria will reach the left side of the heart and enter the systemic blood circulation which circulates blood out of the heart to other organs. From here, bacteria can develop and infect other organs other than the lungs.

Bacteria that attack the alveoli can also enter the vessels of the spleen causing swollen lymph nodes.

Risk factors

What are the risk factors that can cause miliary TB?

Milier TB is a health condition that can occur in almost anyone. However, there are several factors that can increase a person's risk for suffering from this disease.

It is important for you to know that having one or more risk factors does not mean you will definitely be exposed to a disease or health condition. Risk factors are just a set of conditions that can increase your chances of contracting a certain disease.

The following are risk factors for miliary TB, namely:

1. Live or travel to an area with a high incidence of tuberculosis

If you travel or live in an area with a high incidence of TB, your risk of contracting miliary TB also increases.

In addition, if you work in a place with a lot of TB bacteria, such as a hospital, clinic, shelter, nursing home, or refuge, your chances of contracting miliary TB are even greater.

2. Have a bad immune system

Not only in certain environments, some people with poor immune systems are more likely to suffer from tuberculosis than ordinary people.

There are several types of diseases that can affect your body's immune system, namely people with HIV / AIDS, diabetes, kidney failure, malnutrition, and rheumatoid arthritis .

People who have recently undergone an organ transplantation process also have reduced immunity, so they are also more at risk of developing miliary TB disease.

Diagnosis & Treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is this disease diagnosed?

The test for miliary TB is done similarly to tests for other types of TB, such as the tuberculin skin test or the Mantoux test.

Skin tests are generally used to detect the presence of tuberculosis bacterial infection. However, this test is considered less effective for detecting this condition. This is due to the high numbers false negative . Result false negative can occur due to the low number of bacteria in this type of TB when compared to other types of tuberculosis.

Therefore, usually the doctor will ask you to undergo several other TB tests in order to get a more accurate diagnosis for Milier TB, such as:

• Chest X-ray
• Sputum or sputum culture
• Bronchoscopy
• Open lung biopsy
• CT / MRI scan of the head
• Blood culture
• Fundoscopy
• Electrocardiography

Tuberculosis blood test, also known as Interferon Gamma Release Assay (IGRA), is one way to diagnose miliary tuberculosis. Blood tests are done to find out how your body's immune system responds to the bacteria that cause tuberculosis.

There are two types of IGRA that have been approved and are in accordance with the standards U.S. Food and Drug Administration (FDA), that is QuantiFERON® – TB Gold In-Tube test (QFT-GIT) and T-SPOT® TB test (T-Spot).

How to treat miliary TB?

Doctors will usually treat tuberculosis with a combination of several types of TB drugs, such as:

• Isoniazid (INH),
• Streptomycin and ethambutol (Myambutol)
• Rifampicin (Rifadin, Rimactane)
• Pyrazinamide (pms-Pyrazinamide, Tebrazid)

These drugs are usually referred to as first-line medications, or are given first time as a treatment option for TB.

Treatment generally lasts 6-12 months. It is important for you to know that you must take these medicines according to the instructions from your doctor, and make sure you take them until they run out. This is to prevent drug resistance, in which bacteria will not respond to drugs.

If it turns out that TB antibiotic resistance persists, the doctor will give you second-line drugs which include:

• Ethionamide (Trecator-SC)
• Moxifloxacin (Avelox)
• Levofloxacin (Levaquin)
• Cycloserine (Seromycin)
• Kanamycin (Kantrex)

Second-line drugs will cause more TB side effects than first-line medications. If it is found that during treatment it is known that the patient also has miliary TB which attacks the brain causing meningitis, treatment can be extended for up to 12 months.

Side effects of miliary TB treatment commonly experienced by patients include inflammation of the liver if the patient is consumed pyrazinamide , rifampicin, and isoniazid.

Prevention

What are the ways to prevent miliary TB?

The most effective way to prevent miliary TB disease is by injecting vaccinations. The Bacillus Calmette-Guerin (BCG) vaccine is effective in preventing control of TB transmission, especially in children.

Apart from giving vaccinations, preventing the spread of TB can also be done with TB treatment for people who are infected with TB bacteria in their bodies, both active and latent TB patients. Therefore, it is important to inject this vaccine as a preventive measure for tuberculosis and other types of tuberculosis.

If you have any questions, consult your doctor for the best solution to your problem.