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Tuberculosis in the kidney
Tuberculosis in the kidney


Tuberculosis in the lung
Tuberculosis in the lung


Coal worker's lungs - chest X-ray
Coal worker's lungs - chest X-ray


Coal workers pneumoconiosis - stage II
Coal workers pneumoconiosis - stage II


Coal workers pneumoconiosis - stage II #2
Coal workers pneumoconiosis - stage II #2


Coal workers pneumoconiosis, complicated
Coal workers pneumoconiosis, complicated


Tuberculosis, advanced - chest X-rays
Tuberculosis, advanced - chest X-rays


Sarcoid, stage II - chest X-ray
Sarcoid, stage II - chest X-ray


Miliary tuberculosis
Miliary tuberculosis


Erythema multiforme, circular lesions - hands
Erythema multiforme, circular lesions - hands


Erythema nodosum associated with sarcoidosis
Erythema nodosum associated with sarcoidosis


Circulatory system
Circulatory system


Definition:

Disseminated tuberculosis (TB) is a contagious bacterial infection that has spread from the lungs to other parts of the body through the blood or lymph system .

See also: Tuberculosis - pulmonary



Alternative Names:

Miliary tuberculosis; Tuberculosis - disseminated; Extrapulmonary tuberculosis



Causes, incidence, and risk factors:

Tuberculosis infection can develop after inhaling droplets sprayed into the air from a cough or sneeze by someone infected with the Mycobacterium tuberculosis bacteria. Small areas of infection, called granulomas (granular tumors), develop in the lungs.

The usual site of tuberculosis is the lungs, but other organs can be involved. In the U.S., most people with primary tuberculous get better and have no further evidence of disease. Disseminated disease develops in the small number of infected people whose immune systems do not successfully contain the primary infection.

Disseminated disease can occur within weeks after the primary infection, or may lie dormant for years before causing illness. Infants, the elderly, and those infected with HIV are at higher risk for the disease worsening, because of their weaker immune systems.

In disseminated disease, organs and tissues affected can include:

  • Bones and joints
  • Bronchus
  • Cervical lymph nodes
  • Eye
  • Larynx (voice box)
  • Lining of the abdominal cavity (peritoneum)
  • Lining of the brain and spinal cord (meninges)
  • Lining of the heart (pericardium)
  • Organs of the male or female urinary and reproductive systems
  • Skin
  • Small bowel
  • Stomach

The risk of catching TB increases when you are in contact with people who have the disease, if you live in crowded or unsanitary conditions, and if you have poor nutrition.

Recently, TB has been seen more often in the U.S. Factors that may be causing this increase are tuberculosis infections in people with AIDS and HIV , and increasing numbers of homeless people.

Another matter of concern is the development of drug-resistant strains of TB. Incomplete treatment of TB infections (such as not taking medications for the prescribed length of time) can contribute to the development of drug-resistant strains of bacteria.

About half of AIDS patients with a CD4 count less than 200 who develop TB will have disseminated disease (not localized disease, as in lung tuberculosis).



Symptoms:

The primary infection usually has no symptoms.

Symptoms of disseminated tuberculosis include:

  • Cough
  • Fatigue
  • Fever
  • General discomfort, uneasiness, or ill feeling (malaise )
  • Shortness of breath
  • Sweating
  • Weight loss

Other symptoms that can occur with this disease:

  • Abdominal swelling
  • Chills
  • Joint pain
  • Pale skin due to anemia (pallor)
  • Swollen glands

Note: The symptoms will depend upon the affected areas of the body.



Signs and tests:

A physical exam may show:

Tests for tuberculosis include:

This disease may also alter the results of the following tests:

  • Mycobacterial culture of bone marrow
  • Peripheral smear
  • Serum calcium (may be elevated)


Treatment:

The goal of treatment is to cure the infection with antitubercular drugs. These drugs include:

  • Amikacin
  • Ethambutol
  • Ethionamide
  • Isoniazid (INH)
  • Moxifloxacin
  • Para-aminosalicylic acid (PAS)
  • Streptomycin

Daily oral doses are continued for 1 year or longer. Directly observed therapy, in which a health care provider watches the patient take the prescribed antitubercular drugs, is the most effective strategy for some patients. In this case, drugs may be given 2 or 3 times per week, as prescribed by a doctor.

For atypical tuberculosis infections, or drug-resistant strains, other drugs may be used to treat the infection. Treatment starts with a minimum of three drugs.

Hospitalization may be necessary to prevent spreading the disease to others until the infectious period is over, usually 2-4 weeks after the start of therapy. People can continue their normal activities after the infectious period.



Support Groups:



Expectations (prognosis):

Most disseminated forms of TB respond well to treatment.



Complications:

All medications used to treat TB can have side effects. Rifampin, pyrazinamide, and isoniazid may cause liver inflammation. Rifampin may also turn the tears and urine an orange or brown color, and can stain contact lenses and undergarments. Ethambutol may reduce vision or cause color blindness.

Other complications include:



Calling your health care provider:

Call your health care provider if you know or suspect that you have been exposed to TB. All forms of TB need prompt evaluation and treatment.



Prevention:

The vaccine BCG is sometimes given to people who don't have tuberculosis, but who have been or may be exposed to people with untreated TB. Its effectiveness is unclear. It is rarely used in the United States but is often used abroad, in countries with higher rates of tuberculosis.



References:

Iseman DE. Tuberculosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 345.




Review Date: 12/3/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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789 Central Avenue, Dover, NH 03820
Phone: (603) 742-5252
Toll free: 1 (877) 201-7100