Soon after Rich and McCordock reported their conclusions, a concern was raised that this mode of entry does not explain the frequent association of miliary tuberculosis and TBM (70, 119). Donald et al. (49) reexamined the original publications and subsequent publications on this matter and concluded that disseminated tuberculosis plays an important role in the development of TBM in children, inasmuch as disseminated tuberculosis increases the probability that a Rich focus will develop, thus enhancing the chances of a fortuitous rupture of the lesion, leading to clinical TBM (70).
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