From the Guidelines
Miliary tuberculosis is a severe form of TB that requires prompt treatment with a standard four-drug regimen, and its symptoms include persistent high fever, night sweats, extreme fatigue, weight loss, and shortness of breath. The symptoms of miliary tuberculosis (TB) are diverse and can affect multiple organs, including the lungs, liver, spleen, and central nervous system. Common symptoms include:
- Persistent high fever
- Night sweats
- Extreme fatigue
- Weight loss
- Shortness of breath
- Cough
- Abdominal pain
- Enlarged liver or spleen
- Headache or altered mental status if the brain is involved Treatment of miliary TB typically involves a standard four-drug regimen consisting of isoniazid, rifampin, ethambutol, and pyrazinamide for two months, followed by isoniazid and rifampin for an additional 4-7 months, for a total of 6-9 months of therapy 1. However, it's essential to note that the new guidelines for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment, released by the World Health Organization in 2022, do not recommend the use of the new regimens for miliary TB, and instead, suggest longer treatments for extensive forms of extrapulmonary TB, including miliary TB 1. Patients with HIV co-infection or CNS involvement typically require longer treatment durations of 9-12 months. Adjunctive corticosteroids, such as prednisone, may be beneficial for patients with severe disease, especially with meningeal involvement. Treatment should be initiated promptly as miliary TB has a high mortality rate if left untreated. Patients require close monitoring for drug side effects, including liver function tests and visual acuity checks for ethambutol.
From the FDA Drug Label
Although there have not been the same kinds of carefully conducted controlled trials of treatment of Extra pulmonary tuberculosis as for pulmonary disease, increasing clinical experience indicates that a 6 to 9 month short-course regimen is effective Because of the insufficient data, military tuberculosis, bone/joint tuberculosis, and tuberculous meningitis in infants and children should receive 12 month therapy.
The symptoms of miliary tuberculosis (TB) are not directly mentioned in the provided drug labels.
- Treatment of miliary TB is mentioned as requiring a 12-month therapy for infants and children due to insufficient data 2, 2.
- The treatment guidelines for pulmonary tuberculosis can be applied to extra-pulmonary forms of the disease, including miliary TB.
- Adjunctive therapies such as surgery and corticosteroids may be necessary for extra-pulmonary tuberculosis, including miliary TB.
From the Research
Symptoms of Miliary Tuberculosis
- Fever [(3,4,5,6)]
- Night sweats [(3,4,7)]
- Weight loss [(3,4,7)]
- Anorexia 4
- Fatigue 4
- Hepatomegaly 4
- Splenomegaly 4
- Choroid tubercules 4
- Anemia 4
- Pancytopenia 4
- Accelerated erythrocyte sedimentation rate 4
Treatment of Miliary Tuberculosis
- Multidrug anti-TB regimen consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol [(3,4)]
- Adjunctive corticosteroids for severe manifestations 3
- Close monitoring and supportive care 3
- Quadruple anti-TB treatment 4
Diagnosis of Miliary Tuberculosis
- Radiologic criterion: diffuse miliary nodules on CT scan and X-ray of the chest [(3,4)]
- Pathological criterion: granulomas in tissue samples of liver, lung, and bone marrow [(4,5,6)]
- Microbiological criterion: positive acid-fast bacilli, cultures for Mycobacterium tuberculosis [(3,4,6)]
- Tuberculin skin test 4
- Morning temperature spikes characteristic of miliary TB 5