ARDS from miliary tuberculosis successfully treated with ECMO

Vesteinsdottir, Edda; Myrdal, Gunnar; Sverrisson, Kristinn; Skarphedinsdottir, S. J.; Guðlaugsson, Ólafur; Kárason, Sigurbergur

doi:10.1016/j.rmcr.2019.01.005

Cited by 6 publications

(11 citation statements)

References 19 publications

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“…For the mother, miliary TB may cause multiple organ involvement, such as liver dysfunction and bone marrow TB, as well as ARDS [ 22 ], for which ECMO has proven to be an effective treatment [ 24 ]. The disease may also have a far-reaching impact on the foetus, such as a higher risk of miscarriage and preterm delivery, intrauterine growth retardation and stillbirth, and congenital TB [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of pregnancy complicated with miliary tuberculosis

et al. 2021

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Background Pregnancy complicated with tuberculosis is increasingly common. The clinical characteristics of pregnancy complicated with miliary tuberculosis are summarized in this study. Methods A retrospective analysis of pregnant patients with miliary tuberculosis was performed in terms of epidemiology, demography, clinical characteristics, laboratory tests, treatment, and prognosis. Results Of the 23 patients that were included, 12 became pregnant after in vitro fertilization combined with embryo transfer (IVF-ET). The average gestational age at symptom onset was 13.96 weeks, and the average time from symptom onset to diagnosis was 33 days. Clinical symptoms included fever, dyspnoea, cough, headache, abdominal pain, and chest pain. Extrapulmonary tuberculosis occurred in 10 patients, respiratory failure in 11 patients, and ARDS in 9 patients. Chest HRCT showed diffusely distributed miliary nodules in all patients. Six patients were on mechanical ventilation, two underwent ECMO, and one died. Symptoms appeared in the first trimester of nine pregnancies after IVF-ET and in the second trimester of seven natural pregnancies. Conclusions Miliary tuberculosis can occur in pregnant patients, especially in patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Lacking specificity, the common clinical characteristics include elevated inflammation markers, anaemia, low lymphocyte count, and multiple miliary nodules shown on a chest HRCT scan. Half of patients with miliary tuberculosis may develop respiratory failure, and some may progress to ARDS. Therefore, infertile patients should be required to undergo TB screening before undergoing IVF-ET, and preventive anti-TB treatment should be given to patients with latent TB infections or untreated TB disease. Key Message Miliary tuberculosis can occur in pregnant patients, especially in pregnant patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Many patients develop respiratory failure or ARDS.

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Section: Discussionmentioning

confidence: 99%

Clinical analysis of pregnancy complicated with miliary tuberculosis

et al. 2021

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“…A previous case report indicated that high-dose steroid therapy for pulmonary TB contributed to a decreased requirement for long-term steroid use [7]. However, evidence for the effect of corticosteroids on ARDS due to disseminated TB is still lacking [15]. Any pharmacotherapy used in the present case did not appear to contribute to the rapid improvement.…”

Section: Discussionmentioning

confidence: 57%

“…Previous reports on successful treatment of VV-ECMO in TB-induced ARDS focused on prolonged use [[6], [7], [8],14]. The duration of use of VV-ECMO in previous studies was 36 [6], 52 [7], and 89 [8,15] days. In the recent report, a patient with miliary TB-induced ARDS on ECMO therapy without ventilator weaned from ECMO after 50 days [13].…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis-induced acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation

Binh

Manabe

et al. 2019

Respiratory Medicine Case Reports

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Tuberculosis (TB) is a rare but known cause of acute respiratory distress syndrome (ARDS) with a high mortality. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) may be an alternative option for treating TB-induced ARDS. However, the literature on TB-induced ARDS treated with VV-ECMO is limited and the most of them were prolonged therapy. We report on a-48-year-old man with TB-induced ARDS who was successfully treated by short-term use of VV-ECMO (5 days). He was developed symptoms and hospitalized with severe dyspnea in a local hospital for 3 days before admission to our hospital. At the time when he was transferred to our hospital, his chest computed tomography showed bilateral, diffuse and consolidative shadows all over the lungs, the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO 2 /FiO 2 ) was 50 mmHg, and respiratory system compliance was 12.5 mL/cmH 2 O. Two days after admission, Mycobacterium tuberculosis was detected by a sputum smear examination and he was diagnosed with TB-induced ARDS. VV-ECMO support was then initiated with administration of anti-TB drugs and systemic corticosteroid treatment. On the 4 th day of ECMO support, his PaO 2 /FiO 2 increased to 400 mmHg and lung compliance increased to 45 mL/cmH 2 O. He was weaned from ECMO on the 5th day of ECMO support and was extubated at the 8th day. He was discharged from hospital on the 47th hospitalized day and continued anti-TB medication at home. VV-ECMO is effective for TB-induced ARDS even in short-term administration if progression of ARDS is rapid.

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“…The evidence of ECMO support in these cases is scarce and is only in the form of case reports. However, the experience had been positive, with 11/12 cases with good results [ 2 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , 17 , 18 ], with the non-recovered patient being a case where TB was diagnosed post mortem [ 16 ]. Most of these cases used VV-ECMO, with VA-ECMO reserved for concomitant cardiologic involvement [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, ECMO has been used as therapy for ARDS due to TB. However, published evidence is scarce, with only 12 cases published to our knowledge [ 2 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ]. We present a case of a patient with ARDS secondary to TB in whom ECMO was used as a salvage therapy in the middle of SARS-CoV-2 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation for tuberculosis pneumonia with empyema

Besa¹,

Morales²,

Salas³

et al. 2021

Respiratory Medicine Case Reports

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Acute respiratory distress syndrome (ARDS) caused by Mycobacterium Tuberculosis (TB) is a rare entity. Extracorporeal membrane oxygenation (ECMO) therapy had been used as an effective therapy for this cases, but the evidence is scarce. We present a case that took place in the middle of SARS-CoV2 pandemic. A 33-year-old female presented with ARDS due to pulmonary TB infection (pneumonia with empyema and pneumothorax), which required invasive mechanical ventilation with poor response. Long term veno-arterio-venous (VAV) ECMO, overlapped with veno-venous ECMO, was used as a salvage therapy with a good response for a total of 26 days. This is an example of the effectiveness of this therapy in this scenario, never described before. The fact that this therapy was used in the middle of SARS-CoV2 pandemic, with limited resources available, was remarkable, but it was encouraged by previous successful experiences.

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ARDS from miliary tuberculosis successfully treated with ECMO

Cited by 6 publications

References 19 publications

Clinical analysis of pregnancy complicated with miliary tuberculosis

Clinical analysis of pregnancy complicated with miliary tuberculosis

Tuberculosis-induced acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation for tuberculosis pneumonia with empyema

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