What is disseminated Tuberculosis (TB)?

From the Guidelines

Disseminated tuberculosis (TB) is a severe form of TB infection where the Mycobacterium tuberculosis bacteria spread throughout the body via the bloodstream, affecting multiple organs beyond the lungs. This condition occurs when TB bacteria enter the bloodstream and lymphatic system, allowing them to travel to distant sites. Disseminated TB typically affects the liver, spleen, bone marrow, lymph nodes, and meninges, but can involve virtually any organ system. It's most common in people with weakened immune systems, particularly those with HIV/AIDS, young children, and the elderly. Some key points to consider in the management of disseminated TB include:

• A 6-month regimen is recommended for tuberculosis at multiple sites and for miliary tuberculosis, although there are limited data from controlled clinical trials addressing this issue, as noted by the american thoracic society/centers for disease control and prevention/infectious diseases society of america 1.
• Treatment requires a standard regimen, and the use of corticosteroid therapy may be useful for treating respiratory failure caused by disseminated tuberculosis, although there are no data to support its use, as suggested by expert opinion 1.
• The American Academy of Pediatrics (AAP) recommends 9 months of treatment for children with disseminated tuberculosis, highlighting the need for individualized treatment approaches based on patient population and clinical presentation 1. Without proper treatment, disseminated TB has a high mortality rate, but with appropriate therapy, most patients can recover completely.

From the Research

Definition and Characteristics of Disseminated TB

• Disseminated tuberculosis (TB) is a life-threatening disease resulting from the hematogenous spread of Mycobacterium tuberculosis 2.
• It is characterized by a subtle, non-specific clinical presentation, which usually reflects the underlying organ involved 2.
• The diagnosis of disseminated TB is challenging due to its non-specific symptoms and limited tools for confirmatory laboratory diagnosis 2.

Clinical Presentation and Diagnosis

• Patients with disseminated TB often present with a febrile illness of 2 to 4 months' duration, and may have organomegaly affecting the liver, spleen, and lymph nodes 3.
• A miliary pattern on chest radiography is a common finding, but approximately 10%-15% of patients may have normal chest radiography 2.
• Imaging studies, such as high-resolution computed tomography, can help determine the involved sites and guide technicians to obtain appropriate specimens for diagnosis 2, 3.
• Clinical confirmation of the diagnosis of disseminated TB is usually based on bacteriological or histological evidence 2.

Treatment and Outcomes

• The treatment of disseminated TB is the same as that for pulmonary tuberculosis 3.
• First-line anti-TB drugs have been shown to be effective in treating disseminated TB, with a good response to treatment 2.
• The overall mortality from disseminated TB is nearly 20% 3.
• Treatment regimens, such as isoniazid, rifampin, pyrazinamide, and ethambutol, have been used successfully to treat disseminated TB 4, 5.