Tuberculosis on the intensive care unit

Abstract

Patients with tuberculosis admitted to the intensive care unit represent a small (1–3%) yet significant subset of the global tuberculosis burden. This article reviews current evidence supporting the diagnosis and management of patients with tuberculosis admitted to an intensive care unit from a combination of cohort studies and national and international tuberculosis guidelines. This review considers admission, diagnosis, mechanical ventilation, infection control, treatment and prognosis of patients with tuberculosis admitted to an intensive care unit. It highlights both diagnostic and management challenges and areas where ambiguity remains and further evidence is required.

The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

“…6 Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Manaus, AM, Brazil. 7 Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.…”

“…The diagnosis of pulmonary tuberculosis (PTB) in ICU settings presents challenges, mainly to obtain fast and reliable microbiological confirmation. In people living with HIV (PLWH) and critically ill patients, the diagnosis of TB may be more difficult due to the greater frequency of paucibacillary forms in advanced stages of immunodepression and develop complications related to invasive procedures [7].…”

“…Microbiological sampling from a mechanically ventilated patient will require an endotracheal aspirate (ETA), a non-directed bronchial lavage or a bronchoalveolar lavage (BAL) [7]. Although it is an easy-to-perform, lowcost and non-invasive method, the ETA has several limitations, such as low specificity and high false positive rates for the diagnosis of pulmonary infections [8].…”

Managing severe tuberculosis and its sequelae: from intensive care to surgery and rehabilitation

“…In such cases, a high index of suspicion is required in order to make the diagnosis. A diagnosis of tuberculosis should be suspected in patients who are contacts of tuberculosis patients and in those who have risk factors for the disease 20 . The possibility of reactivation of latent tuberculosis infection due to stress or immunosuppression should also be considered 21 …”

“…Although rifampin is available in an intravenous formulation in some countries (not currently in Brazil), other antituberculosis drugs generally are not. In most cases, antituberculosis drugs are administered parenterally 20 25 Furthermore, although some drugs can adhere to the nasogastric tube (e.g., rifampin), they can be administered intravenously to achieve and maintain therapeutic blood levels, which makes them more efficacious 25 .…”