Severe Tuberculosis Sepsis in an Immunocompetent Patient

Bridges, Debbie; Bedimo, Roger

doi:10.1016/j.amjmed.2005.08.033

Cited by 17 publications

(12 citation statements)

References 13 publications

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“…Persisting hypotension suggested cardiac (or pericardial) involvement [10]; or overwhelming TB with sepsis [11,12]. Although Mtb itself is effectively killed by appropriate antimicrobial therapy, an exaggerated immune response elicited by the release of virulence factors from the cell wall-possibly mediated via IL-1 and TNF pathways-may be explanatory for the development of PR [11][12][13]. This mechanism is also able to clarify the therapeutic effect exhibited by TNF-a inhibition, in patients who do not respond to corticosteroids [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…In the past, corticosteroids have been in use to manage a variety of forms of extrapulmonary TB [ 8 , 9 ]. Persisting hypotension suggested cardiac (or pericardial) involvement [ 10 ]; or overwhelming TB with sepsis [ 11 , 12 ]. Although Mtb itself is effectively killed by appropriate antimicrobial therapy, an exaggerated immune response elicited by the release of virulence factors from the cell wall—possibly mediated via IL-1 and TNF pathways—may be explanatory for the development of PR [ 11 – 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Corticosteroid therapy for the management of paradoxical inflammatory reaction in patients with pulmonary tuberculosis

et al. 2020

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Background Paradoxical reaction after the initiation of tuberculosis treatment is defined as increased inflammation following effective antimycobacterial treatment. This is a phenomenon that can severely complicate a patient's recovery, potentially leading to further morbidity and residual deficits. Paradoxical reaction remains poorly understood regarding its pathophysiology and management. Only a limited number of reports look critically at the available therapeutic options, with evidence of the efficacy of prednisolone therapy being primarily limited to extrapulmonary PR only. Case We describe two HIV negative patients who were admitted to our department with pulmonary tuberculosis, presenting with inflammatory patterns attributable to PR and their response to adjunctive steroid therapy. Discussion and Conclusions The presented cases further highlight the need for immunological studies and randomized trials for corticosteroid therapy are needed to better understand this phenomenon as well as provide an evidence-base for antiinflammatory treatment. Furthermore, by means of this case series, we are also able to highlight the potential variability in the symptomatology of the lesser known PR phenomenon, in which we observed a hypotensive shock-like syndrome not previously described in literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Corticosteroid therapy for the management of paradoxical inflammatory reaction in patients with pulmonary tuberculosis

et al. 2020

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“…Viral transcription is the consequence of viral sepsis 21 . RHBDD2 containing module showed the involvement of 'Tuberculosis pathway', which is an infrequent complication of tuberculosis, and is related to septic shock with multiple organ dysfunction [22][23][24] . 'Osteoclast differentiation and 'Lysosome pathways' ware upregulated, which are implicated in septic shock and disregulation in latter causes exacerbate human sepsis 25,26 .…”

Section: Discussionmentioning

confidence: 99%

Transcription Factors STAT5A and SPI1 Reveals RHBDD2 as a Potential Biomarker in Sepsis and Septic Shock

Ali

Shehwana

Hanif

et al. 2020

Preprint

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Sepsis is a serious health situation caused by uncontrolled infection and septic shock is a severe condition of sepsis. RHBDD2 is a member of the rhomboid superfamily which is overexpressed in different types of cancer and associated with ER stress and estrogen receptor. Using microarray gene expression data and using different computational techniques this study investigated the role of RHBDD2 in sepsis and septic shock. Finds functional annotation of RHBDD2 using co-expression analysis and identified the deregulation of RHBDD2 in sepsis using differential expression analysis. Results show that RHBDD2 is overexpressed in sepsis and septic shock. The GO enrichment analysis, KEGG pathways, and biological functions of the RHBDD2 co-expressed genes module show that it is involved in most of the sepsis-related biological functions and also plays a role in most of the infection-related pathways which lead to sepsis and septic shock. RHBDD2 is regulated by STAT5A and SPI1 transcription factors in sepsis and septic shock. The identification of the RHBDD2 as a biomarker may facilitate in septic shock diagnosis, treatment, and prognosis.

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“…However, there is no clear consensus on steroid use in HIV negative patients, but can be considered[37]. A careful review of the clinical course in a few case reports and series depicts a similar clinical course[40-42]. Hence, one should evaluate the possibility of IRIS in clinical scenarios of TBSS after TB antimicrobial administration.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis septic shock, an elusive pathophysiology and hurdles in management: A case report and review of literature

Mishra¹,

Patel²,

Singasani³

et al. 2019

WJCCM

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BACKGROUNDTuberculosis (TB) is a rare etiology of the septic shock. Timely administration of the anti-microbial agents has shown mortality benefit. Prompt diagnosis and a high index of suspicion are crucial to the management. We present three cases of TBSS with poor outcome in the majority despite timely and susceptible antibiotic administration.CASE SUMMARYSixty-seven-year-old woman with latent TB presented with fever, cough, and shortness of breath. She was promptly diagnosed with active TB and started on the appropriate anti-microbial regimen; she had a worsening clinical course with septic shock and multi-organ failure after initiation of antibiotics. Thirty-three-year-old man immunocompromised with acquired immune deficiency syndrome presented with fever, anorexia and weight loss. He had no respiratory symptoms, and first chest X-ray was normal. He had enlarged liver, spleen and lymph nodes suspicious for lymphoma. Despite broad-spectrum antibiotics, he succumbed to refractory septic shock and multi-organ failure. It was shortly before his death that anti-TB antimicrobials were initiated based on pathology reports of bone marrow and lymph node biopsies. Forty-nine-year-old woman with asthma and latent TB admitted with cough and shortness of breath. Although Initial sputum analysis was negative, a subsequent broncho-alveolar lavage turned out to be positive for acid fast bacilli followed by initiation of susceptible ant-TB regimen. She had a downward spiral clinical course with shock, multi-organ failure and finally death.CONCLUSIONWorse outcome despite timely initiation of appropriate antibiotics raises suspicion of TB immune reconstitution as a possible pathogenesis for TB septic shock.

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Severe Tuberculosis Sepsis in an Immunocompetent Patient

Cited by 17 publications

References 13 publications

Corticosteroid therapy for the management of paradoxical inflammatory reaction in patients with pulmonary tuberculosis

Corticosteroid therapy for the management of paradoxical inflammatory reaction in patients with pulmonary tuberculosis

Transcription Factors STAT5A and SPI1 Reveals RHBDD2 as a Potential Biomarker in Sepsis and Septic Shock

Tuberculosis septic shock, an elusive pathophysiology and hurdles in management: A case report and review of literature

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