Miliary tuberculosis in Qatar: a review of 32 adult cases.

BACKGROUND: This study was conducted to define the demographic, clinical and laboratory features, methods of diagnosis and outcome, in patients with miliary tuberculosis (TB) in Qatar, and compare the findings with other reported studies. PATIENTS AND METHODS: A retrospective review of 32 cases of miliary TB treated at the Hamad Medical Corporation during a seven-year period (1992 to 1998) was undertaken. The 32 patients comprised 24 males and 8 females, and their mean age was 33.3 years. The majority (90%) were expatriates. The clinical features of the patients were similar to those of previously reported series. The most common presenting symptoms were fever, cough, night sweats, weight loss and sputum production. Fever, rales, lymphadenopathy, altered mental status and hepatomegaly were the most common signs. Chest radiograph was abnormal in 94% of patients, and showed a miliary pattern in 69%. Sputum, cerebrospinal fluid, bronchial washings, and urine smears for acid-fast bacilli were rarely positive, however, cultures for Mycobacterium tuberculosis were positive in 54.8%, 37.5%, 33%, and 25%, respectively. The diagnoses in the majority of patients were made on the basis of the clinical presentation and supported by a miliary pattern on chest radiograph. In those whom chest radiograph did not show the classic miliary pattern, transbronchial biopsy was diagnostic in 1 of 2 patients (50%), bone marrow biopsy in 5 of 11 (45%), liver biopsy in 1 of 2 (50%), and lymph node biopsy in all 7 patients (100%). Thirty patients were treated with a four-drug regimen consisting of isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol. Mortality due to miliary TB was 3%.
CONCLUSION: Miliary TB is common in Qatar, especially among expatriates. Because the clinical features of the disease are nonspecific, a high index of suspicion is essential for early diagnosis in order avoid delays in therapy and poor outcome.