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J Crit Care. 2018 Jun;45:184-196. doi: 10.1016/j.jcrc.2018.03.015. Epub 2018 Mar 13.

The critically ill patient with tuberculosis in intensive care: Clinical presentations, management and infection control.

Author information

1
Department of Internal Medicine, University of Calabar, Calabar, Nigeria; National Aspergillosis Centre, University Hospital of South Manchester, Manchester, United Kingdom.
2
Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
3
Department of Anesthesia and Intensive Care, Cairo University, Cairo, Egypt.
4
Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda.
5
Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
6
Department of Microbiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
7
Division of Infection and Immunity, University College London Medical School, and NIHR Biomedical Research Center at University College of London Hospitals, London, United Kingdom.
8
Department of Critical Care, University College of London Hospital, London, United Kingdom; Department of Anaesthesia and Intensive Care Medicine, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria. Electronic address: Martin.Duenser@i-med.ac.at.
9
Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of Witwatersrand, Johannesburg, South Africa.

Abstract

Tuberculosis (TB) is one of the top ten causes of death worldwide. In 2016, there were 490,000 cases of multi-drug resistant TB globally. Over 2 billion people have asymptomatic latent Mycobacterium tuberculosis infection. TB represents an important, but neglected management issue in patients presenting to intensive care units. Tuberculosis in intensive care settings may present as the primary diagnosis (active drug sensitive or resistant TB disease). In other patients TB may be an incidental co-morbid finding as previously undiagnosed sub-clinical or latent TB which may re-activate under conditions of stress and immunosuppression. In Sub-Saharan Africa, where co-infection with the human immunodeficiency virus and other communicable diseases is highly prevalent, TB is one of the most frequent clinical management issues in all healthcare settings. Acute respiratory failure, septic shock and multi-organ dysfunction are the most common reasons for intensive care unit admission of patients with pulmonary or extrapulmonary TB. Poor absorption of anti-TB drugs occurs in critically ill patients and worsens survival. The mortality of patients requiring intensive care is high. The majority of early TB deaths result from acute cardiorespiratory failure or septic shock. Important clinical presentations, management and infection control issues regarding TB in intensive care settings are reviewed.

KEYWORDS:

Drug-resistant tuberculosis; Infection control; Intensive care; Latent tuberculosis; Multi-drug resistant tuberculosis; Tuberculosis

PMID:
29571116
DOI:
10.1016/j.jcrc.2018.03.015
[Indexed for MEDLINE]

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