Military Tuberculosis: Signs, origins, detection, remedies, and additional details
Miliary tuberculosis (TB) is a rare but potentially severe form of the disease that affects multiple parts of the body. This article aims to provide a clear understanding of the three main types of miliary TB: pulmonary TB, acute miliary TB, and cryptic miliary TB.
Pulmonary TB is the most common form, involving active infection in the lungs. Its onset is usually insidious with gradual development of symptoms such as persistent cough, lack of energy, weight loss, fever with drenching night sweats, chest pain possibly due to pleurisy, and hemoptysis (coughing up blood). Lung lesions can cause extensive tissue destruction, cavitation, and scarring, leading to respiratory failure if untreated.
On the other hand, acute miliary TB results from widespread hematogenous dissemination of Mycobacterium tuberculosis, leading to numerous tiny granulomas (lesions) throughout multiple organs including the lungs. It represents a severe, disseminated form that can progress rapidly and can affect multiple systems simultaneously. Symptoms tend to be more systemic and severe, including high fever, malaise, weight loss, and organ-specific dysfunction depending on dissemination. It may present abruptly and is more common in immunocompromised individuals or young children.
Cryptic miliary TB refers to a form of miliary TB where the chest radiograph appears normal or nearly normal despite systemic disease. The symptoms tend to be non-specific and subtle, often including general signs like unexplained fever, weight loss, and malaise. This form may be clinically challenging to diagnose due to the lack of evident pulmonary lesions on imaging despite systemic infection.
| TB Type | Presentation Onset | Main Symptoms | Imaging Findings | Severity and Course | |-------------------|--------------------|-----------------------------------------------|------------------------------------|---------------------------------| | Pulmonary TB | Insidious | Persistent cough, weight loss, fever, night sweats, chest pain, hemoptysis | Pulmonary infiltrates, cavitation, fibrosis | Gradual deterioration, lung damage leading to respiratory failure | | Acute Miliary TB | Rapid/acute | High fever, malaise, weight loss, multi-organ symptoms | Diffuse micronodular ("millet seed") lesions in lungs and others | Severe, potentially fatal if untreated | | Cryptic Miliary TB | Subtle/cryptic | Non-specific systemic symptoms like fever, weight loss | Often normal or minimally abnormal chest radiograph | Difficult diagnosis due to lack of clear radiographic signs |
Acute miliary TB typically affects people under the age of 40 years and presents with additional symptoms such as body temperature rising in the evenings, fever spikes in the mornings, and skin reactions. Miliary TB can occur when a TB lesion erodes into a blood vessel and releases bacteria into a person's bloodstream.
The Food and Drug Administration (FDA) has approved a group of medications called antitubercular medications for the treatment of TB, including miliary TB. Due to the varied nature of miliary TB symptoms, diagnosis can be challenging and may involve asking questions about symptoms, requesting a full medical history, performing a physical examination, and ordering various tests to confirm the diagnosis or rule out other possible causes.
[1] Centers for Disease Control and Prevention. (2021). Disseminated and Military TB. Retrieved from https://www.cdc.gov/tb/topic/forms/disseminated.htm [2] World Health Organization. (2021). Miliary tuberculosis. Retrieved from https://www.who.int/news-room/fact-sheets/detail/miliary-tuberculosis [5] American Thoracic Society. (2021). Diagnosis of Tuberculosis. Retrieved from https://www.thoracic.org/patients/patient-resources/resources/tuberculosis/diagnosis.pdf
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