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Disseminated tuberculosis
Miliary tuberculosis; Tuberculosis - disseminated; Extrapulmonary tuberculosis
Disseminated tuberculosis is a contagious mycobacterial infection in which mycobacteria have spread from the lungs to other parts of the body through the blood or lymph system .
Lymph system
The lymph system is a network of organs, lymph nodes, lymph ducts, and lymph vessels that make and move lymph from tissues to the bloodstream. The l...
Causes
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 bacterium. The resulting lung infection is called primary TB.
The usual site of TB is the lungs ( pulmonary TB ), but other organs can be involved. In the United States, 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.
Pulmonary TB
Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may spread to other organs.
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 medicines. Infants and older adults are also at higher risk.
Your risk of catching TB increases if you:
- Are around people who have the disease (such as during overseas travel)
- Live in crowded or unclean conditions
- Have poor nutrition
The following factors can increase the rate of TB infection in a population:
- Increase in HIV infections
- Increase in number of homeless people with unstable housing (poor environment and nutrition)
- The appearance of drug-resistant strains of TB
Symptoms
Disseminated tuberculosis can affect many different body areas. Symptoms depend on the affected areas of the body and can include:
- Abdominal pain or swelling
- Chills
- Cough and shortness of breath
- Fatigue
- Fever
-
General discomfort, uneasiness, or ill feeling (
malaise
)
Malaise
Malaise is a general feeling of discomfort, illness, or lack of well-being.
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- Pale skin due to anemia (pallor)
- Sweating
-
Swollen glands
Swollen glands
Lymph nodes are present throughout your body. They are an important part of your immune system. Lymph nodes help your body recognize and fight germ...
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Exams and Tests
The health care provider will perform a physical exam. This may show:
-
Swollen liver
Swollen liver
Hepatomegaly is swelling of the liver beyond its normal size. If both the liver and spleen are enlarged, it is called hepatosplenomegaly.
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Swollen lymph nodes
Swollen lymph nodes
Lymph nodes are present throughout your body. They are an important part of your immune system. Lymph nodes help your body recognize and fight germ...
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Swollen spleen
Swollen spleen
Splenomegaly is a larger-than-normal spleen. The spleen is an organ in the upper left part of the belly.
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Tests that may be ordered include:
- Biopsies and cultures of affected organs or tissues
-
Bronchoscopy
for
biopsy
or culture
Bronchoscopy
Bronchoscopy is a test to view the airways and diagnose lung disease. It may also be used during the treatment of some lung conditions.
ImageRead Article Now Book Mark ArticleBiopsy
A biopsy is the removal of a small piece of tissue for laboratory examination.
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Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
ImageRead Article Now Book Mark Article - CT scan of the affected area
- Fundoscopy may reveal retinal lesions
- Interferon-gamma release blood test, such as the QFT-Gold test to test for prior exposure to TB
-
Lung biopsy
Lung biopsy
An open lung biopsy is surgery to remove a small piece of tissue from the lung. The sample is then examined for cancer, infection, or lung disease....
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- Pleural biopsy
-
Tuberculin skin test
(PPD test)
Tuberculin skin test
The PPD skin test is a method used to diagnose silent (latent) tuberculosis (TB) infection. PPD stands for purified protein derivative.
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Sputum examination and
cultures
Cultures
Routine sputum culture is a laboratory test that looks for germs that cause infection. Sputum is the material that comes up from air passages when y...
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Thoracentesis
Thoracentesis
Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest....
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Treatment
The goal of treatment is to cure the infection with medicines that fight the TB bacteria. Treatment of disseminated TB involves a combination of several medicines (usually 4). All medicines are continued until lab tests show which work best.
You may need to take many different pills for 6 months or longer. It is very important that you take the pills the way your provider instructed.
When people do not take their TB medicines as instructed, the infection can become much more difficult to treat. The TB bacteria can become resistant to treatment. This means the medicines no longer work.
When there is concern that a person may not take all the medicines as directed, a provider may need to watch the person take the prescribed medicines. This approach is called directly observed therapy. In this case, medicines may be given 2 or 3 times a week, as prescribed by a provider.
You may need to stay at home or be admitted to a hospital for 2 to 4 weeks to avoid spreading the disease to others until you are no longer contagious.
Your provider may be required by law to report your TB illness to the local health department. Your health care team will ensure that you receive the best care.
Outlook (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.
Possible Complications
Complications of disseminated TB can include:
-
Adult respiratory distress syndrome (
ARDS
)
ARDS
Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the bl...
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Liver inflammation
Liver inflammation
Hepatitis is swelling and inflammation of the liver.
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- Return of the disease
Medicines used to treat TB can cause side effects, including:
- Changes in vision
- Orange- or brown-colored tears and urine
- Rash
-
Liver inflammation
Liver inflammation
Drug-induced liver injury is an injury of the liver that may occur when you take certain medicines. Other types of liver injury include:Viral hepatit...
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A vision test may be done before treatment so your doctor can monitor any changes in the health of your eyes.
When to Contact a Medical Professional
Call your 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. 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 provider.
References
Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 324.
Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis . In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 251.
-
Tuberculosis in the kidney - illustration
Kidneys can be damaged by tuberculosis. Tuberculosis generally affects the lungs, but may cause infection in many other organs in the body. (Image courtesy of the Centers for Disease Control and Prevention.)
Tuberculosis in the kidney
illustration
-
Tuberculosis in the lung - illustration
Tuberculosis is caused by a group of organisms: Mycobacterium tuberculosis, M bovis, M africanum and a few other rarer subtypes. Tuberculosis usually appears as a lung (pulmonary) infection. However, it may infect other organs in the body. Recently, antibiotic-resistant strains of tuberculosis have appeared. With increasing numbers of immunocompromised individuals with AIDS, and homeless people without medical care, tuberculosis is seen more frequently today. (Image courtesy of the Centers for Disease Control and Prevention.) M bovis M africanum
Tuberculosis in the lung
illustration
-
Coal worker's lungs - chest X-ray - illustration
This chest x-ray shows coal worker's lungs. There are diffuse, small, light areas on both sides (1 to 3 mm) in all parts of the lungs. Diseases that may result in an x-ray like this include: simple coal workers pneumoconiosis (CWP) - stage I, simple silicosis, miliary tuberculosis, histiocytosis X (eosinophilic granuloma), and other diffuse infiltrate pulmonary diseases.
Coal worker's lungs - chest X-ray
illustration
-
Tuberculosis, advanced - chest X-rays - illustration
Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, and can cause tissue death. These chest x-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying size that run together (coalesce). Arrows indicate the location of cavities within these light areas. The x-ray on the left clearly shows that the opacities are located in the upper area of the lungs toward the back. The appearance is typical for chronic pulmonary tuberculosis but may also occur with chronic pulmonary histiocytosis and chronic pulmonary coccidioidomycosis. Pulmonary tuberculosis is making a comeback with new resistant strains that are difficult to treat. Pulmonary tuberculosis is the most common form of the disease, but other organs can be infected.
Tuberculosis, advanced - chest X-rays
illustration
-
Miliary tuberculosis - illustration
Mycobacterium tuberculosis
Miliary tuberculosis
illustration
-
Erythema multiforme, circular lesions - hands - illustration
Erythema multiforme lesions are circular and may appear in concentric rings (often called target lesions). Target lesions may also be associated with other medical conditions such as herpes infection, streptococcal infection, tuberculosis (TB), or as a reaction to chemicals or medications.
Erythema multiforme, circular lesions - hands
illustration
-
Erythema nodosum associated with sarcoidosis - illustration
This picture shows reddish-purple, hard (indurated), painful nodules (Erythema nodosum) that occur most commonly on the shins. These lesions may be anywhere on the body and may be associated with tuberculosis (TB), sarcoidosis, coccidioidomycosis, systemic lupus erythematosis (SLE), fungal infections, or in response to medications.
Erythema nodosum associated with sarcoidosis
illustration
-
Circulatory system - illustration
Blood used by the body is brought back to the heart and lungs by the veins of the body. Once the blood has gathered more oxygen from the lungs, it is pumped back out to the body through the arteries.
Circulatory system
illustration
-
Tuberculosis in the kidney - illustration
Kidneys can be damaged by tuberculosis. Tuberculosis generally affects the lungs, but may cause infection in many other organs in the body. (Image courtesy of the Centers for Disease Control and Prevention.)
Tuberculosis in the kidney
illustration
-
Tuberculosis in the lung - illustration
Tuberculosis is caused by a group of organisms: Mycobacterium tuberculosis, M bovis, M africanum and a few other rarer subtypes. Tuberculosis usually appears as a lung (pulmonary) infection. However, it may infect other organs in the body. Recently, antibiotic-resistant strains of tuberculosis have appeared. With increasing numbers of immunocompromised individuals with AIDS, and homeless people without medical care, tuberculosis is seen more frequently today. (Image courtesy of the Centers for Disease Control and Prevention.) M bovis M africanum
Tuberculosis in the lung
illustration
-
Coal worker's lungs - chest X-ray - illustration
This chest x-ray shows coal worker's lungs. There are diffuse, small, light areas on both sides (1 to 3 mm) in all parts of the lungs. Diseases that may result in an x-ray like this include: simple coal workers pneumoconiosis (CWP) - stage I, simple silicosis, miliary tuberculosis, histiocytosis X (eosinophilic granuloma), and other diffuse infiltrate pulmonary diseases.
Coal worker's lungs - chest X-ray
illustration
-
Tuberculosis, advanced - chest X-rays - illustration
Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, and can cause tissue death. These chest x-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying size that run together (coalesce). Arrows indicate the location of cavities within these light areas. The x-ray on the left clearly shows that the opacities are located in the upper area of the lungs toward the back. The appearance is typical for chronic pulmonary tuberculosis but may also occur with chronic pulmonary histiocytosis and chronic pulmonary coccidioidomycosis. Pulmonary tuberculosis is making a comeback with new resistant strains that are difficult to treat. Pulmonary tuberculosis is the most common form of the disease, but other organs can be infected.
Tuberculosis, advanced - chest X-rays
illustration
-
Miliary tuberculosis - illustration
Mycobacterium tuberculosis
Miliary tuberculosis
illustration
-
Erythema multiforme, circular lesions - hands - illustration
Erythema multiforme lesions are circular and may appear in concentric rings (often called target lesions). Target lesions may also be associated with other medical conditions such as herpes infection, streptococcal infection, tuberculosis (TB), or as a reaction to chemicals or medications.
Erythema multiforme, circular lesions - hands
illustration
-
Erythema nodosum associated with sarcoidosis - illustration
This picture shows reddish-purple, hard (indurated), painful nodules (Erythema nodosum) that occur most commonly on the shins. These lesions may be anywhere on the body and may be associated with tuberculosis (TB), sarcoidosis, coccidioidomycosis, systemic lupus erythematosis (SLE), fungal infections, or in response to medications.
Erythema nodosum associated with sarcoidosis
illustration
-
Circulatory system - illustration
Blood used by the body is brought back to the heart and lungs by the veins of the body. Once the blood has gathered more oxygen from the lungs, it is pumped back out to the body through the arteries.
Circulatory system
illustration
Review Date: 12/10/2015
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, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
