DISSEMINATED TUBERCULOSIS WITH AND WITHOUT A MILIARY PATTERN ON CHESTRADIOGRAPH - A CLINICAL-PATHOLOGICAL-RADIOLOGIC CORRELATION

SETTING: Province of Manitoba, Canada. OBJECTIVE: TO describe the char acteristics of disseminated tuberculosis (TBD) with and without a mili ary pattern on chest radiograph, to determine the mortality, and to id entify the demographic and clinical features associated with survival. DESIGN: A retrospective case review. RESULTS: Of 2013 cases of active tuberculosis reported to the Provincial Tuberculosis Registry between January 1979 and December 1993, 56 had disseminated disease. The odds of developing TBD were significantly higher in females. Compared to t hose with a miliary pattern (n = 42), those without a miliary pattern on chest radiograph (n = 14) were significantly more likely to have a risk factor for tuberculosis (86% vs 52%, P < 0.05) and to die (86% vs 21%, P < 0.001). The diagnosis of TBD was significantly more likely t o be made at postmortem in non-miliary compared to miliary patients (4 3% vs 5%, P < 0.05). Amongst patients with a miliary pattern, the pres ence of one or more risk factors for tuberculosis was associated with a significantly higher mortality (P < 0.05). Meningitis was very uncom mon and did not determine the outcome. CONCLUSION: Disseminated tuberc ulosis patients without a miliary pattern on chest radiograph have an extremely high mortality rate; those with a miliary pattern may also s uccumb, especially if co-morbid with a condition known to increase the risk of tuberculosis.