Zaghba N, El Hachimi K, Benjelloun H, Yassine N
Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc.
Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc.
Rev Pneumol Clin. 2018 Feb;74(1):28-34. doi: 10.1016/j.pneumo.2017.10.003. Epub 2017 Dec 14.
Tuberculosis miliary is a severe and rare form of tuberculosis. It is often due to a haematogenous spread of the bacillus of Koch and represents less than 2 % of tuberculosis.
We conducted a retrospective study of 81 cases of tuberculous miliary collected at the Department of respiratory diseases of the Ibn Rochd university hospital in Casablanca between September 2003 and November 2016.
A female predominance was noted with 58 % of the cases. The average age was 36 years. The history of tuberculosis was found in eight cases and tuberculous tuberculosis in eleven cases, postpartum in five cases, diabetes in three cases and trisomy 21 in one case. The clinical picture was dominated by altered general status in all cases, and fever in 69 cases (86 %). Chest x-ray showed a miliary aspect in all cases, cardiomegaly in two cases, pyopneumothorax in three cases, and opacities excavated in five other cases. The intradermal tuberculin reaction, performed in all cases, was positive in 26 cases, and sputum oscillations were positive in 21 cases. The dissemination report found cerebromeningeal involvement in nine cases, with cerebral tuberculomas in five cases, pericarditis in four cases, mediastinal and peripheral adenopathies in nine cases each. Bouchut tubercles were found in nine cases. Antibacillary therapy was started as a matter of urgency, according to the national TB control program with the old regimen (2SHRZ/7RH) and the new regimen (2RHZEb/7RH) in all cases. The outcome was good in 55 cases (68.9 %), 17 patients were lost to follow-up, and 11 deaths were reported.
We insist on this work on the severity of the tuberculous miliary and the need for early and urgent therapeutic management.
粟粒性肺结核是一种严重且罕见的肺结核形式。它通常是由于科赫杆菌的血行播散所致，占肺结核病例的比例不到2%。
我们对2003年9月至2016年11月期间在卡萨布兰卡伊本·罗什德大学医院呼吸科收集的81例粟粒性结核病例进行了回顾性研究。
发现女性占优势，占病例的58%。平均年龄为36岁。8例有肺结核病史，11例有结核性胸膜炎病史，5例为产后发病，3例有糖尿病史，1例有21三体综合征。所有病例的临床表现均以全身状况改变为主，69例（86%）有发热。胸部X线检查在所有病例中均显示粟粒状表现，2例有心脏扩大，3例有脓气胸，另外5例有空洞性混浊。所有病例均进行了皮内结核菌素反应，26例呈阳性，21例痰涂片阳性。播散情况显示，9例有脑脑膜受累，5例有脑结核瘤，4例有心肌炎，9例有纵隔及外周淋巴结肿大。9例发现有布舒氏结节。根据国家结核病控制规划，所有病例均紧急开始抗结核治疗，采用旧方案（2SHRZ/7RH）和新方案（2RHZEb/7RH）。55例（68.9%）预后良好，17例失访，11例死亡。
我们坚持这项关于粟粒性结核严重性以及早期紧急治疗管理必要性的研究。
