ACUTE MILIARY TUBERCULOSIS

Pathogenesis
Hilar lymphadenopathy’ occurs in cases of primary tuberculosis. In course of time these lymph nodes become
cascous and softened and ultimately these softened material are poured into a nearby pulmonary venule or arteriole
commonly in the former as its wall is thin, If these are poured into a venule, the infected material is disseminated throughout
the body and this is called generalised miliary tuberculosis then these materials enter an arteriole, only pulmonar
ssemination occurs according to the segmental distributic of the pulmonary arteriole. This is called pulmonary miliary
uberculosis. Because lymphadenopathy occurs in primar tuberculosis and as primary tuberculosis occurs in children.
miliary tuberculosis is also common in children. Each localised lesion resembles millet seed in appearance
and therefore the disease is called miliary tuberculosis. The lesions are also found in liver, spleen, lymph node, bone
marrow and meninges. Microscopic picture ach localised lesion reveals the following from within outwards:
a) Central necrotic area without caseation.
b) Scanty or no giant cells.
c) Few lymphocytes.
d) Least vascular reaction.
As there is no caseation sputum is negative for AFB.
Clinical Features
Onset is usually sudden, rarely insidious which is seen in
middle aged and elderly individuals.
Symptoms
1. Fever-High remittent or intermittent type, rarely a low grade pyrexia of undetermined origin (PUO) may be the presenting features.
2. Headache.
3. Severe sweating.

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