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Disseminated tuberculosis

Definition

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

Alternative Names

Miliary tuberculosis; Tuberculosis - disseminated; Extrapulmonary tuberculosis

Causes, incidence, and risk factors

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

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

Disseminated disease can occur within weeks of the primary infection. Sometimes, it does not occur until years after you become infected. You are more likely to get this type of TB if you have a weakened immune system due to disease (such as AIDS) or certain medications. Infants and the elderly are also at higher risk.  

Your risk of catching TB increases if you:

  • Are around people who have the disease
  • Live in crowded or unclean conditions
  • Have poor nutrition

TB has become more common in the U.S. in recent years. This rise may be due to a larger number of TB infections in people with AIDS and HIV, an increase in the number of immune-suppressing medications, and increasing numbers of homeless people. A rise in drug-resistant strains of TB bacteria also plays a role.

Symptoms

Disseminated tuberculosis can affect many different body areas. Symptoms depend on the affected areas of the body and can 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

Signs and tests

A physical exam may show:

Tests for TB may include:

The disease can also alter the results of the following tests:

  • Complete blood count (CBC)
  • Peripheral blood smear
  • Blood calcium level
  • Erythrocyte sedimentation rate
  • C-reactive protein

Treatment

The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of disseminated TB involves a combination of several drugs (usually four). All drugs are continued until lab tests show which work best.

Commonly used drugs include:

  • Isoniazid
  • Rifampin
  • Pyrazinamide
  • Ethambutol

Other drugs that may be used include:

  • Amikacin
  • Ethionamide
  • Moxifloxacin
  • Para-aminosalicylic acid
  • Streptomycin

You may need to take many different pills at different times of the day for 6 months or longer. It is very important that you take the pills the way your health care provider instructed.

When people do not take their TB medications as instructed, the infection can become much more difficult to treat. The TB bacteria can become resistant to treatment. This means the drugs no longer work.

When there is concern that a patient may not take all the medication as directed, a health care provider may need to watch the person take the prescribed drugs. This approach is called directly observed therapy. In this case, drugs may be given 2 or 3 times per week, as prescribed by a doctor.

You may need to stay at home or be admitted to a hospital for 2 - 4 weeks to avoid spreading the disease to others until you are no longer contagious.

Your doctor or nurse is required by law to report your TB illness to the local health department. Your health care team will be sure that you receive the best care.

Support Groups

You can ease the stress of illness by joining a support group. Sharing with others who have the same experiences and problems as you do can help you feel more in control.

Expectations (prognosis)

Most forms of disseminated TB respond well to treatment. The tissue that is affected, such as the bones or joints, may have permanent damage due to the infection.

Complications

Complications of disseminated TB can include:

  • Adult respiratory distress syndrome (ARDS)
  • Liver inflammation 
  • Lung failure
  • Return of the disease

Medicines used to treat TB can cause side effects, including liver problems. Other side effects include:

  • Changes in vision
  • Orange- or brown-colored tears and urine
  • Rash

A vision test may be done before treatment so your doctor can monitor any changes in the health of your eyes.

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 and exposure need prompt evaluation and treatment.

Prevention

TB is a preventable disease, even in those who have been exposed to an infected person. Skin testing for TB is used in high risk populations or in people who may have been exposed to TB, such as health care workers.

People who have been exposed to TB should be skin tested immediately and have a follow-up test at a later date, if the first test is negative.

A positive skin test means you have come into contact with the TB bacteria. It does not mean that you have active disease or are contagious. Talk to your doctor about how to prevent getting tuberculosis.

Prompt treatment is extremely important in controlling the spread of TB from those who have active TB disease to those who have never been infected with TB.

Some countries with a high incidence of TB give people a vaccination (called BCG) to prevent TB. However, the effectiveness of this vaccine is controversial and it is not routinely used in the United States.

People who have had BCG may still be skin tested for TB. Discuss the test results (if positive) with your doctor.

References

Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, eds.  Cecil Medicine. 24th ed.Philadelphia, PA: Elsevier Saunders; 2011:chap 332.

Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2009:chap 250.


Review Date: 11/10/2012
Reviewed By: 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 A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
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