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

Authors

Akaninyene Otu, University of Calabar, Calabar, Nigeria
Madiha Hashmi, Aga Khan UniversityFollow
Ahmed M. Mukhtar, Cairo University, Cairo, Egypt
Arthur Kwizera, Makerere University College of Health Sciences, Kampala, Uganda
Simon Tiberi, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
Bruce Macrae, University College London Hospitals NHS Foundation Trust, London, United Kingdom
Alimudin Zumla, University College London Medical School, and NIHR Biomedical Research Center at University College of London Hospitals, London, United Kingdom
Martin W. Dünser, University College of London Hospital, London, United Kingdom
Mervyn Mer, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of Witwatersrand, Johannesburg, South Africa

Document Type

Article

Department

Anaesthesia

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.

Comments

Issue are not provided by the author/publisher

Publication (Name of Journal)

Journal of Critical Care

Recommended Citation

Otu, A., Hashmi, M., Mukhtar, A. M., Kwizera, A., Tiberi, S., Macrae, B., Zumla, A., Dünser, M. W., Mer, M. (2018). The critically ill patient with tuberculosis in intensive care: Clinical presentations, management and infection control. Journal of Critical Care, 45, 184-196.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_anaesth/362