Journal of Lung

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Disseminated Tuberculosis

Disseminated tuberculosis signifies the widespread occurrence of caseating visceral tuberculosis that occurs by hematogenous dissemination of the bacilli from an active caseous focus or foci located in the lung or extrapulmonary sites. Hematogenous dissemination of the bacilli may occur during the course of primary tuberculosis, immediately after the post-primary period, or at a time far remote from the post-primary period as late generalized tuberculosis. A wide spectrum of pathological features occurs as a result of hematogenous dissemination of the bacilli. This spectrum of pathology is determined by the size of the bacillary inoculum load, the virulence of the bacilli, and the status of the host immune response. It ranges from a rare but acute fulminating form due to the release of massive myriads of caseous and necrotic tubercles into the blood with a nonreactive and an anergic response, very low count of CD4+ T-cells with scanty or absent granuloma formation; that form of the disease is only diagnosed at autopsy. If, on the other hand, tuberculous bacteremia is slight with the formation of few tubercles, this discrete type of generalized dissemination is usually without immediate clinical significance.

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