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Disseminated Tuberculosis

Last updated Sept. 3, 2018

Approved by: Maulik P. Purohit MD, MPH

Yale Rosen

Microscopic pathology image showing Disseminated Tuberculosis.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Disseminated TB
  • Extra-Pulmonary Disseminated Tuberculosis
  • Tuberculosis Cutis Disseminate

What is Disseminated Tuberculosis? (Definition/Background Information)

  • Disseminated Tuberculosis (TB) is a contagious bacterial infection that has spread from the lungs to other parts of the body through the blood or lymph system. It is caused by the bacterium called Mycobacterium tuberculosis
  • The infection is acquired through inhalation of droplets sprayed into air from the cough or sneeze of an infected individual. It can occur within weeks of the primary infection or may be inactive for years before causing illness
  • Initially the infection develops in the lungs and then spreads to other parts of the body such as:
    • Bones and joints (causing Tuberculosis Osteomyelitis)
    • Eye (Ocular TB)
    • Intestines (Gastrointestinal TB)
    • Larynx (Laryngeal TB)
    • Peritoneum - the lining of the abdominal cavity (Peritoneal TB)
    • Meninges - the lining of the brain and spinal cord (Meningeal TB)
    • Pericardium - the lining of the heart (Tuberculous Pericarditis)
    • Lymph nodes (TB Lymph Adenitis)
    • Organs of the male and female reproductive and urinary system (TB of the Genitourinary System)
    • Skin (Cutaneous TB)
    • Stomach (Gastric TB)
  • The signs and symptoms of Disseminated Tuberculosis mainly depend upon the organ involved. But the common symptoms include fatigue, weight loss, loss of appetite, and fever. A definitive diagnosis of the condition is made by culture and biopsy studies of the infected organ
  • The treatment for Disseminated Tuberculosis includes the use of anti-TB medication, which is usually a combination of 4 antibiotics. With early diagnosis and prompt, and complete treatment, the prognosis is generally good

Who gets Disseminated Tuberculosis? (Age and Sex Distribution)

  • Disseminated Tuberculosis can occur in any age group, but generally older adults and infants are more vulnerable to the disease
  • It can affect both male and female genders
  • Disseminated Tuberculosis that arises from a primary lung infection occurs worldwide; all racial and ethnic groups can be affected

What are the Risk Factors for Disseminated Tuberculosis? (Predisposing Factors)

The risk factors associated with Disseminated Tuberculosis include:

  • Older adults (over the age of 65 years) and infants
  • Individuals with poor immune system, such as those infected with HIV, individuals on immune suppressing medications (such as for organ transplantation), cancer patients, etc.
  • Frequent contact with infected individuals
  • Living in crowded areas, in poor sanitary conditions
  • Poor nutrition in the diet
  • Diabetic patients
  • Silicosis
  • End-stage renal disease

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Disseminated Tuberculosis? (Etiology)

  • Disseminated Tuberculosis is a contagious bacterial infection that has spread from the lungs to other parts of the body through the blood or lymph system
  • It is caused by Mycobacterium tuberculosis, a pathogenic bacterium
  • The infection is acquired through inhalation of respiratory droplets from the cough or sneeze of an infected individual

What are the Signs and Symptoms of Disseminated Tuberculosis?

The signs and symptoms exhibited by Disseminated Tuberculosis depend on the part of the body affected and may include:

  • Persistent cough that can be blood-tinged
  • Fatigue for a prolonged time period
  • Fever that can be mild or severe, sweating, and chills
  • General discomfort and uneasiness, headache
  • Feeling of tiredness, shortness of breath
  • Weight loss
  • Abdominal swelling
  • Joint pains
  • Pale skin due to anemia
  • Swollen glands
  • Lymphadenopathy (enlargement of the lymph nodes)
  • Hepatomegaly and splenomegaly (enlargement of the liver and spleen respectively)
  • Adrenal gland insufficiency
  • Multi-organ dysfunction

How is Disseminated Tuberculosis Diagnosed?

The diagnosis of Disseminated Tuberculosis may include a through physical exam and assessment of symptoms, along with the evaluation of one’s medical history.

  • The physical examination may reveal the following:
    • Enlarged liver and spleen
    • Swollen lymph nodes
  • The TB skin test, also known as purified protein derivative (PPD) test or tuberculin test
    • The skin test involves an injection of a small amount of tuberculin (which contains the tuberculosis bacteria) into the lower arm
    • 48-72 hours after the injection, a healthcare provider examines the site of injection
    • If there is swelling in the area, the test is positive and it indicates that the individual is infected with Mycobacterium tuberculosis
    • If no swelling is noted, the test is negative and the individual is not infected
  • TB screening blood test:
    • A blood sample is collected and tested, to see how the individual’s immune system responds to the tuberculosis bacteria
    • Like the TB skin test, a positive test indicates the presence of TB bacteria in the individual; a negative test indicates that there is no infection

Other tests for diagnosing Disseminated Tuberculosis shall include:

  • Biopsy of the affected organ and tissues: A small sample of tissue is removed and sent to the laboratory for examination under the microscope by a pathologist
  • Culture of sputum
  • Culture of the affected organ and tissues: The microorganisms are made to grow in the laboratory by providing certain essential substances for its growth, in order to confirm their presence
  • Bronchoscopy for biopsy or culture: Examination of the airways with the help of a thin, viewing instrument
  • Chest X-ray
  • Computed Tomography (CT) scan of the affected organ or region
  • Fundoscopy (eye examination)
  • Complete blood count and blood calcium level

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Disseminated Tuberculosis?

The complications of Disseminated Tuberculosis may include:

  • Adult respiratory distress syndrome (ARDS) causing acute lung failure
  • Liver inflammation
  • Lung failure
  • Relapse of the disease

How is Disseminated Tuberculosis Treated?

The treatment for Disseminated Tuberculosis (TB) involves:

  • A combination of 4 antibiotic, anti-TB medication given over a period of 6-12 months depending upon the organ involved
  • The most commonly used drugs include:
    • Isoniazid
    • Rifampin
    • Pyrazinamide
    • Ethambutol
    • Streptomycin
  • Directly observed therapy (DOT): Where the doctor or nurse monitors the patient whether medicines are being taken regularly and at the correct time. If medicines are not taken properly, the infection might get resistant to the antibiotics, which then gets very difficult to treat
  • The type of medication, dosage, combination of drugs and duration of treatment are determined by the healthcare provider, based upon each individual’s particular health condition and other factors (such as age, pre-existing medical conditions, etc.)
  • It is extremely important to take the full regimen of medications, so that the bacteria may be eliminated from an individual’s body. Otherwise, the infection may linger and become active later on.

Additionally, inappropriate or insufficient treatment can lead to the development of multidrug resistant forms of the TB-causing bacterium.

  • A multidrug resistant Tuberculosis (MDR-TB) develops when:
    • The prescribed drug course/regimen is not followed properly
    • The drugs being used have not been formulated properly, or are of poor quality
    • Improper storage of drugs takes place, such that their efficiency is compromised
    • Stopping drugs prematurely when the symptoms improve, without regard for the prescribed treatment duration
  • The MDR-TB is resistant to at least 2 of the most effective drugs to treat the disease. This form of disease is more difficult to treat
  • A form of disease known as extreme drug-resistant TB (XDR-TB) may develop when the bacterium develops resistance to several of the most effective drugs against TB

How can Disseminated Tuberculosis be Prevented?

Disseminated TB can be prevented by early diagnosis and treatment of pulmonary tuberculosis. The preventive measures may include:

  • Prompt treatment of pulmonary TB to control spread of the disease to other organs
  • Avoid contact with infected individuals, especially in closed and crowded areas. If such a contact is unavoidable, then proper respiratory protective equipment, such as a mask, should be used
  • Getting treated once an individual has come into active contact with TB-infected individuals (i.e., those having confirmed tuberculosis infection)
  • Conducting skin testing or PPD tests in high-risk population exposed to the disease, in order to identify people with silent (latent) disease
  • Getting BCG vaccination to prevent the disease. However, the effectiveness of the vaccine is currently being debated upon. BCG has been shown to reduce the rate of tuberculosis in children in developing countries
  • Healthcare workers and individuals in close contact with the TB patients should follow strict hygiene and preventative measures

Regular medical screening at periodic intervals with tests, and physical examinations are crucial, and highly recommended (for prevention and early diagnosis).

What is the Prognosis of Disseminated Tuberculosis? (Outcomes/Resolutions)

  • With early diagnosis and prompt treatment, the prognosis of Disseminated Tuberculosis is generally good. Untreated disease can lead to complications, which can be fatal
  • The symptoms often improve within 2-3 weeks of starting medication. A complete recovery may take several months though
  • In individuals with HIV infection and other conditions that weaken one’s immune system, the prognosis depends on many factors and is usually guarded

Additional and Relevant Useful Information for Disseminated Tuberculosis:

Some fungal infections can cause symptoms similar to Disseminated Tuberculosis; individuals with suspicious symptoms should always alert/contact their healthcare providers, who are specially trained to deal with infectious diseases.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 17, 2015
Last updated: Sept. 3, 2018