Epidemiology and pathology of miliary and extrapulmonary tuberculosis
- John Bernardo, MD
John Bernardo, MD
- Professor of Medicine and Research Professor of Biochemistry
- Boston University School of Medicine
Miliary tuberculosis (TB) refers to clinical disease resulting from the hematogenous dissemination of Mycobacterium tuberculosis. The term "miliary" was coined in 1700 by John Jacobus Manget, who likened the appearance of the involved lung with its surface covered with firm small white nodules to numerous millet seeds (picture 1).
Miliary TB can arise as a result of progressive primary infection or via reactivation of a latent focus with subsequent spread. The term miliary TB was originally a pathologic and then a radiographic description; it is now used more broadly (and incorrectly) by some to denote all forms of progressive, widely disseminated TB, whether or not disease presents with the classic radiographic or pathologic nodular appearance characteristic of hematogenous spread.
Tuberculosis may be classified according to site of disease as pulmonary or extrapulmonary; miliary disease has been classified as both an extrapulmonary and a pulmonary form of TB.
The epidemiology and pathology of miliary TB will be reviewed here. The clinical manifestations, diagnosis, treatment, and prevention of miliary TB are discussed separately. (See "Clinical manifestations, diagnosis, and treatment of miliary tuberculosis".)
The epidemiology of miliary tuberculosis (TB) has been altered by use of chemotherapy for treatment of malignancy, use of biologic agents, the HIV epidemic, and immigration patterns. For reporting purposes, cases with both pulmonary and extrapulmonary disease are classified as pulmonary TB by the United States Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) [1,2].
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- Risk factors
- - Age
- - Medical conditions
- - Other factors
- Mechanisms of disease
- - Progressive primary disease
- - Reactivation of a latent focus
- - Iatrogenic infection
- Clinicopathologic patterns of disease
- - Acute miliary tuberculosis
- - Late generalized tuberculosis
- - Anergic tuberculosis
- Host and pathogen factors