Miliary tuberculosis in Qatar: A review of 32 adult cases

This study was conducted to define the demographic, clinical andlaboratory features, methods of diagnosis and outcome, in patients withmilitary tuberculosis (TB) in Qatar, and compare the findings with otherreported studies. A retrospective review of 32 cases of military TB treatedat the Hamad Medical Corporation during a seven year period (1992 to 1998)was undertaken. The 32 patients comprised 24 males and 8 females, and theirmean age was 33.3 years. The majority (90%) were expatriates. The clinicalfeatures of the patients were similar to those of previously reported series.The most common presenting symptoms were fever, cough, night sweats, weightloss and sputum production. Fever, rales, lymphadenopathy, alerted mentalstatus and hepatomegaly were the most common signs. Chest radiograph wasabnormal in 94% of patients, and showed a military pattern in 69%. Sputum,cerebrospinal fluid, bronchial washings and urine smears for acid-fastbacilli were rarely positive, however, cultures for Mycobacteriumtuberculosis were positive in 54.8%, 37.5%, 33% and 25% respectively. Thediagnoses in the majority of patients were made on the basis of the clinicalpresentation and supported by a military pattern on chest radiograph. Inthose whom chest radiograph did show the classic military pattern,transbranchial biopsy was diagnostic in 1 of 2 patients (50%), bone marrowbiopsy in 5 of 11 (45%), liver biopsy in 1 of 2 (50%) and lymph node biopsyin all 7 patients (100%). Thirty patients were treated with a four-drugregimen consisting of isoniazid, rifampin, pyrazinamide and streptomycin orethambutol. Mortality due to miliary TB was 3%. Miliary TB is common inQatar, especially among expatriates. Because the clinical features of thedisease are nonspecific, a high index of suspicion is essential for earlydiagnosis in order to avoid delays in therapy and poor outcome. (author)