Adjunctive corticosteroid therapy in patients with pulmonary tuberculosis

Abstract

A significant portion of tuberculosis (TB) patients, especially severe cases, are still being hospitalized, with estimates ranging from 2 to 12%. In addition, patients required mechanical ventilation (MV) in many cases 1,2 . In a study conducted in Brazil, ICU admission was necessary in 8.5% of cases 3 . In another study at a university hospital, 16.7% of the 311 cases of TB were admitted to the ICU and 15.4% required MV 4 . Besides, in-hospital mortality of patients with TB remains high, particularly among patients requiring MV. TB associated with acute respiratory failure has been associated with mortality rates of up to 81.0% [5][6][7][8][9] .Several factors have been identified as predictive of mortality among TB patients, such as delay in diagnosis, irregular treatment, human immunodeficiency virus infection, malnutrition, and multidrug-resistant TB 4,[10][11][12][13] . In a study 10 that evaluated 311 patients with TB, MV and negative sputum smear were predictors of in-hospital death in multivariate analysis. In another retrospective cohort study 4 with 67 patients requiring intensive care, ventilator-associated pneumonia and early intensive care unit admission were risk factors for in-hospital mortality. In addition, serum levels of albumin, reflecting the nutritional status, were associated with higher mortality in ICU patients with TB and respiratory failure 14,15 .In the treatment of TB, corticosteroids are used as adjuvants, especially in meningeal and pericardial TB. Corticosteroids can allow anti-TB drugs to penetrate granulomas, undoing their formation. Moreover, they inhibit the release of cytokines and lymphokines 16,17 . In other forms of the disease, especially in severe TB, its use is controversial 16,[18][19][20][21][22] . Therefore, the aim of the present study is to assess whether the use of corticosteroids in the treatment of pulmonary TB patients in MV is associated with in-hospital mortality.

Effect of Low Doses of Dexamethasone on Experimental Pulmonary Tuberculosis

“…Synthetic GCs, such as dexamethasone (DEX), represent TB’s only clinically approved adjunctive chemotherapeutics [ 11 , 12 ]. GCs are host-directed drugs with a demonstrated beneficial effect on the survival of TB patients [ 13 , 14 , 15 , 16 ].…”

“…GCs are host-directed drugs with a demonstrated beneficial effect on the survival of TB patients [ 13 , 14 , 15 , 16 ]. However, the effect of GCs on TB patients remains controversial because there are studies that did not find any beneficial effect of the use of GCs in pulmonary TB [ 12 , 17 ]. Although GCs have been used as adjunctive therapy in TB, the effects of their immunomodulatory activity during mycobacterial infections remain unknown.…”