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miliary tuberculosis
Miliary tuberculosis (also known as "disseminated tuberculosis", "tuberculosis cutis acuta generalisata",〔 and "Tuberculosis cutis disseminata"〔) is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and accounts for up to 20% of all extra-pulmonary tuberculosis cases.
== Etiology ==
Miliary tuberculosis is a form of tuberculosis that is the result of ''Mycobacterium tuberculosis'' travelling to extrapulmonary organs, such as the liver, spleen and kidneys.〔Sharma, S. K., Mohan, A., Sharma, A., & Mitra, D. K. (2005). Miliary Tuberculosis: New Insights Into An Old Disease. The Lancet Infectious Diseases, 5(7), 415–430.〕 Although it is well understood that the bacteria spread from the pulmonary system to the lymphatic system and eventually the blood stream, the mechanism by which this occurs is not well understood.〔Krishnan, N., Robertson, B. D., & Thwaites, G. (2010). The Mechanisms And Consequences Of The Extra-pulmonary Dissemination Of Mycobacterium Tuberculosis. Tuberculosis, 90(6), 361–366.〕
One proposed mechanism is that tuberculous infection in the lungs results in erosion of the epithelial layer of alveolar cells and the spread of infection into a pulmonary vein.〔〔Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). ''Robbins Basic Pathology'' (8th ed.). Saunders Elsevier. pp. 516–522 ISBN 978-1-4160-2973-1〕 Once the bacteria reach the left side of the heart and enter the systemic circulation, they may multiply and infect extrapulmonary organs.〔 Once infected, the cell mediated immune response is activated. The infected sites become surrounded by macrophages which form granuloma, giving the typical appearance of miliary tuberculosis.〔Jumaah, S. (2012). Tuberculosis. Textbook of Clinical Pediatrics, 1, 1053–1059.〕
Alternatively, the bacteria may attack the cells lining the alveoli and enter the lymph node(s).〔 the bacteria then drain into a systemic vein and eventually reach the right side of the heart. From the right side of the heart, the bacteria may seed—or re-seed as the case may be—the lungs, causing the eponymous "miliary" appearance.
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