How can we improve the provision of high quality care?     Join the Quality & Safety Community

Does anybody know of a good criteria for classifying disseminated tuberculosis? I found this criteria helpful, (from Wang et al 2007), but am looking to compare it to others if applicable--is there a universally accepted definition for disseminated TB?

i. Isolation of Mycobacterium tuberculosis from blood, bone marrow, liver biopsy specimen, or ≥2 noncontiguous organs;
ii. Isolation of M. tuberculosis from 1 organ and histologic demonstration of caseating granulomatous inflammation from the bone marrow, liver biopsy specimen, or another noncontiguous organ;
iii. Isolation of M. tuberculosis from 1 organ and radiographic finding of miliary lung lesions

Thank you!

 
CLEMENT ADESIGBIN
Replied at 6:47 AM, 13 Jan 2014

These criteria appear great. However, is it acceptable that any involvement of the blood is disseminated or as stated all the organs listed must be involved? Pls could you share your reference. Thanks

Xeno Acharya
Replied at 7:04 AM, 13 Jan 2014

Hi Clement, here is the reference. It should be an either/or situation, but I am interested in hearing others input and/or references (paper attached):

Wang, Jann-Yuan, et al. "Disseminated tuberculosis: a 10-year experience in a medical center." Medicine 86.1 (2007): 39-46.

Attached resource:

Gani Alabi
Replied at 11:31 AM, 13 Jan 2014

Disseminated and Miliary TB describe haematogenous spread of the tubercle bacilli from a pulmonary or extra-pulmonary site to two or more viscera. Many experts tend to agree that the main difference is the non-appearance of the typical millet-like nodular lesions on chest radiography in disseminated TB. One thing that is certain is that the haematogenous spread can result in a spectrum of pathological manifestations (from fulminating disease at one end and mild or non-granulomatous disease which is often diagnosed during autopsy on the other end) depending on factors such as inoculum load, virulence of the bacilli and the immune status of the victim. Therefore diagnosis can be difficult and the wise step will be not to think about "universal criteria or definition" but rather to think about a thorough diagnostic pathway which includes, clinical ((signs and symptoms) and laboratory (from smear microscopy to molecular tests, High Resolution Computed Tomography, CT/MRI, Ultrasonography, histopathology, culture, DST etc) investigations and evaluations.

Gurumdi Silas
Replied at 9:06 AM, 15 Jan 2014

DoctorClement and the rest. Complimentarys  of the season. Thanks for the documents. It will surely be useful for my work and others I will share with. 
God bless you.

Silas

  Sign in to reply