Khan Fahmi Y
Department of Medicine, Hamad General Hospital, Doha, Qatar.
J Family Community Med. 2019 May-Aug;26(2):83-91. doi: 10.4103/jfcm.JFCM_106_18.
Disseminated tuberculosis (TB) is a life-threatening disease resulting from the hematogenous spread of . The diagnosis is challenging owing to its subtle nonspecific clinical presentation, which usually reflects the underlying organ involved. Besides, tools for confirmatory laboratory diagnosis are limited. Therefore, a high index of suspicion is required for early diagnosis. Miliary pattern on chest radiography is a common finding that has an important role in the early detection of the disease. Nevertheless, approximately 10%-15% of patients have normal chest radiography. Although abnormalities are present, basic hematologic and biochemical tests as well as tuberculin skin test are nonspecific for the diagnosis. Imaging studies are helpful adjunct tools for disseminated TB as they can help determine the involved sites and guide technicians to obtain appropriate specimens for diagnosis. Clinical confirmation of the diagnosis of disseminated TB is usually based on bacteriological or histological evidence. Response to first-line anti-TB drugs is good as evidenced by many reports. This review aims to present a current update on disseminated TB with emphasis on the diagnostic workup of this devastating condition.
播散性结核病是一种因结核杆菌血行播散导致的危及生命的疾病。由于其临床表现隐匿且无特异性,通常反映出潜在受累器官,故诊断具有挑战性。此外,用于确诊的实验室诊断工具有限。因此,早期诊断需要高度的怀疑指数。胸部X线片上的粟粒样表现是常见发现,在疾病早期检测中起重要作用。然而,约10% - 15%的患者胸部X线片正常。尽管存在异常,但基本血液学和生化检查以及结核菌素皮肤试验对诊断无特异性。影像学检查是播散性结核病有用的辅助工具,因为它们有助于确定受累部位并指导技术人员获取合适的诊断标本。播散性结核病的临床诊断通常基于细菌学或组织学证据。许多报告表明,对一线抗结核药物的反应良好。本综述旨在介绍播散性结核病的最新情况,重点关注这种毁灭性疾病的诊断检查。