Spontaneous Pneumothorax Complicating Miliary Tuberculosis: About a Case at the “Centre Medical Principal De La Gendarmerie Nationale Du Mali”

Introduction: Spontaneous pneumothorax is a rare but serious complication of tuberculosis. Miliary tuberculosis (MT) is a severe form of tuberculosis secondary to hematogenous spread of Mycobacterium tuberculosis. Objective: To report a case of MT complicated by pneumothorax. Methodology: This was a 25-year-old patient, farmer, followed up at the Pneumo-phtisiology department of the CHU du Point G for MT whose condition was improving after the introduction of anti-tuberculosis chemotherapy. He consulted again after experiencing chest pain. Clinical and imaging revealed a Spontaneous pneumothorax complicating MT. The treatment combined anti-tuberculosis chemotherapy, chest drainage and respiratory physiotherapy. Outcome was favorable with improvement of clinical and radiological signs. Conclusion: Pneumothorax complicating MT requires a reflective diagnostic approach and rapid management to improve its prognosis.

Miliary nodules due to secondary pulmonary hemosiderosis in rheumatic heart disease

Pulmonary hemosiderosis is defined as the clinical and functional consequence of iron overload of the lungs,which usually occurs due to recurrent intra-alveolar bleeding.It can manifest as miliary mottling and should be entertained in the differential diagnosis of patients presenting with miliary nodules on chest radiography,especially those with mitral stenosis.The management of secondary pulmonary hemosiderosis secondary to valvular heart disease includes valvuloplasty and/or valve replacement.The radiological opacities may disappear with successful treatment of the underlying valvular disease in many patients.However,they may persist with no physiological impairment to the patient.Here,we present a 32-year-old man with mitral stenosis who presented with fever and miliary shadows on chest radiography,which was ultimately diagnosed as secondary pulmonary hemosiderosis.

Tuberculous meningitis and miliary tuberculosis in Iran:A review

In recent years,the number of cases of extrapulmonary tuberculosis in Iran has increased.The goal of this study was to determine the epidemiological status,clinical symptoms,diagnostic methods,and treatment strategies of extrapulmonary tuberculosis in Iran,with a focus on tuberculosis meningitis and miliary tuberculosis.Between January 1,2000 and June 1,2021,1651 cases of tuberculosis meningitis and miliary tuberculosis were discovered in Iran.The prevalence of tuberculosis meningitis was higher in Sistan and Baluchestan,South Khorasan,and Mazandaran compared with other provinces.The most prevalent symptoms of tuberculous meningitis were fever,anorexia,headache,neck stiffness,loss of consciousness,and vomiting.The most commonly used procedures for diagnosing tuberculous meningitis were polymerase chain reaction and cerebrospinal fluid culture.The most prevalent clinical symptoms of miliary tuberculosis were fever,lethargy,weariness,and anorexia.In 70%of chest radiographs,a miliary pattern was visible.Bone marrow biopsy was used to diagnose miliary tuberculosis in 80%of patients,while bronchoalveolar lavage was used in 20%of cases.The conventional 6-month treatment approach for tuberculous meningitis and miliary tuberculosis was used for all of the participants in the investigations.Given the high prevalence of extrapulmonary tuberculosis patients in Iran and the devastating consequences of the disease,the researchers recommend that further study be done to prevent extrapulmonary tuberculosis in the general population.

Clinical Analysis of Miliary Tuberculosis Patients in Our Tertiary Hospital

Objective: To investigate the clinical characteristics of miliary tuberculosis experienced in our tertiary hospital without a tuberculosis isolation room. Materials and Methods: We obtained a definite diagnosis of tuberculosis for 72 patients in our tertiary hospital between January 2010 and September 2016. There were six patients (8.3%) who were diagnosed with miliary tuberculosis following the isolation of Mycobacterium tuberculosis from several organs, and we analyzed the clinical findings. Results: The average age of the six patients with miliary tuberculosis was 74 years old (3 males and 3 females). All patients had underlying diseases and immunosuppressive treatment was performed for three patients. The detection methods were based on clinical symptoms such as high fever in all patients. Concerning the laboratory findings, three patients showed a negative or indeterminate response for interferon-gamma release assays (IGRAs). Bronchoscopic examinations were performed for five of six patients soon after admission and a definite diagnosis was obtained. Although treatment according to the American Thoracic Society (ATS) guidelines was performed for all patients, three of the six died due to complications or worsening of miliary tuberculosis. Conclusions: Patients with miliary tuberculosis experienced in a tertiary hospital were frequently detected among patients receiving immunosuppressive treatment for a long time. Because these patients showed a rapid progressive clinical course, it is thought to be important to perform bronchoscopic examination proactively for patients suspected of miliary tuberculosis on radiological findings to make an appropriate early diagnosis and start treatment.

The Management Problem of Miliary Tuberculosis in the Service of Pneumo-Phtisiology at the National References University Teaching Hospital of N’Djamena (Chad): About 103 Cases

Introduction: Miliary tuberculosis (MT) is a rare form of tuberculosis (TB) and it is a major public health problem in our countries with limited resources. Materials and Methods: It is a retrospective and descriptive study that started from 1st January 2018 to 31 December 2020 at the pneumo-phtisiology service of the CHU-RN of N’Djamena., All records of patients aged at least 15 years treated for miliary tuberculosis confirmed by X-ray chest were included in our study. Results: The prevalence of TD was 1.5% (n = 103) of all TB diagnosed in the service. The sex ratio was 1.34. The average age was 37.7 years with extremes ranging from 19 to 80 years. A low social economic level was found in 75.7%. The principal comorbidity found in this study was HIV with the prevalence of (22.3%). The general signs were dominated by deterioration of general condition (96.1%) and fever (91.3%). The main symptoms were cough (85.4%) and dyspnea (52.4%). The radiology of chest found a homogeneous dissemination and symmetrical in both lung fields in 100% of cases. Our study reported that 14 (13.6%) of death cases were found among patients. Conclusion: TM is a severe form of TB;it affects a young population in our context. Mortality remains high with prevalence of 13.6% of cases. Early management would improve the prognosis.

Unusual Case of Miliary Tuberculosis with Hepatic Involvement

Miliary tuberculosis (MTB) of the liver can present non-specifically, which often leads to a diagnostic delay. The objective of this clinical case report is to highlight an unusual presentation of miliary TB in a young female patient, who was admitted to hospital with right upper quadrant tenderness and constitutional symptoms. Most of her investigations yielded little to support the diagnosis until a subsequent positive TB Elispot test and CT chest, abdomen and pelvis with contrast were done. Features of this case are discussed, together with anti-tubercular treatment (ATT) strategy utilized for miliary TB with hepatic involvement.

Co-infection with Neisseria mucosa in a patient with tuberculous otitis media

Tuberculous otitis media(TOM) is a rare manifestation caused by Mycobacterium tuberculosis with low incidence rates among extrapulmonary tuberculosis cases. Diagnosis is often delayed because of the presence of several clinical manifestations and the high prevalence of secondary bacterial infections. Few reports have attributed secondary bacterial infections in patients with TOM to commensal Neisseria. Thus, understanding the pathogenic mechanisms and clinical features of commensal Neisseria is important, considering its recent presentation as an infection-causing pathogen. Neisseria mucosa is a commensal inhabitant in humans and is generally considered non-pathogenic but can cause infection in rare cases. Here, we report an atypical secondary infection caused by Neisseria mucosa in an 81-year-old woman with TOM being treated for pulmonary tuberculosis. Direct purulent otorrhea smear microscopy revealed no acid-fast bacilli using Ziehl-Neelsen staining, whereas the phagocytosis of gram-negative cocci by white blood cells was confirmed using Gram staining. Otorrhea culture revealed the growth of N. mucosa. Subsequently, M. tuberculosis infection in the otorrhea was identified using a culture-based method. Vigilance is critical for the early detection of TOM to prevent further complications. This report raises awareness regarding TOM and provides insight into the pathogenicity of N. mucosa in otitis media.

Acute Miliary Tuberculosis and Pelvic Tuberculosis after In vitro Fertilization

Nearly one-fourth of the world’s population is infected with Mycobacterium tuberculosis(MTB).Female genital tuberculosis(TB)is a common cause of infertility in both developing and undeveloped countries.Furthermore,assisted reproduction treatments and pregnancy potentially increase the risk of TB infection and reactivation.In this study,we present the case of a 28-year-old infertile female without a history of TB who developed an acute miliary TB and pelvic TB after in vitro fertilization-embryo transfer(IVF-ET).Elevated serum estrogen levels during controlled ovarian hyperstimulation and T-lymphocyte function inhibition during pregnancy are the risk factors for MTB infection and reactivation.In her 7 th week of gestation,the patient developed fever and spontaneously aborted.Her chest computed tomography images revealed classical miliary TB.Uterine curettage tissue and vaginal secretion samples as well as Gene X-pert MTB/rifampicin(RIF)and TB-RNA test results were positive for MTB.Histological examination of the uterine curettage tissue confirmed the diagnosis of endometrial TB.Treatment with isoniazid,RIF,pyrazinamide,amikacin,and levofloxacin was selected based on the patient’s diagnosis,complications,and test results.Currently,the patient is undergoing anti-TB treatment,and her condition is stable.It is important to rule out the presence of TB in infertile patients before performing IVF-ET to avoid TB dissemination during pregnancy.

Disseminated tuberculosis presenting as meningitis and spondylodiscitis in an immunocompetent adult

Rationale:Disseminated tuberculosis involves the central nervous system in up to a third of cases.However,meningitis and spondylodiscitis due to miliary tuberculosis rarely occur together,particularly in the immuno-competent population.Patient concerns:A 37-year-old immunocompetent male presented with altered level of consciousness for one week and lower back pain with evening pyrexia for one month.Examination revealed spastic paraplegia and left hemiparesis.Diagnosis:Disseminated tuberculosis presenting with meningitis and spondylodiscitis.Interventions:Category I anti-tuberculous therapy with a tapering regimen of intravenous dexamethasone was administered.Outcomes:There was clinical improvement after nine months of treatment.Lessons:Tuberculosis may present with atypical clinical manifestations.Contrast enhanced computed tomography scan or magnetic resonance imaging combined with histopathological features,a high index of suspicion and clinical improvement with anti-tuberculous treatment can confirm the diagnosis in the absence of microbiological evidence,especially in extrapulmonary tuberculosis.