Miliary tuberculosis: Diagnosis difficulties and prognosis factors

Introduction: Miliary tuberculosis (MT) is a form of tuberculosis which is characterized by wide hematogenous dissemination of Mycobacterium tuberculosis into the human body. The clinical presentation.of MT is highly variable. Objective: The aim of this study is to describe diagnosis difficulties and prognosis factors of MT in Tunisian patients. Methods: A retrospective study was conducted in the female adult pulmonary department of the Tunis Chest Disease and Surgery Training Hospital between 2000 and 2010. Results: Seventeen patients were found to have MT. The average age was 50 years [12-89]. Past history of Tb was noted in 1 case. Five patients had Tb contact history. Factors of immunodepression noted in 9 patients were: elderly (n=7), pregnancy (n=1) and corticosteroid therapy (n=1). Immunology of HIV was negative in all patients. Main symptoms were cough and wasting syndrome (n=15). On admission, 7 patients had an acute respiratory failure. Cachexy was noted in 8 cases. Chest X ray showed diffuse miliary shadow in all cases. Diagnosis was confirmed in 7 patients, by microscopic sputum tests (n=5), pleural biopsy (n=1) and lymph node biopsy (n=1). In the other cases (n=10), diagnosis was retained by a high index of clinical suspicion. Multifocal Tb was noted in 5 cases. The extrapulmonary sites were: central nervous system (n= 3), pleura (n=2), vertebral bodies (n=1), lymphatic nodes (n=1). Antituberculous treatment was started in all cases. The outcome was favourable in 15 patients. Two elderly were dead. Tb relapse occurred in 2 cases. Conclusion: MT is a severe disease in witch treatment must be early even without diagnosis confirmation. Advanced age seems to be one important prognosis factors.