Critical Care and Shock

Clinical presentation and outcome of patients diagnosed with active pulmonary tuberculosis in a large critical care unit

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Objective: To examine the presentation and outcome of patients diagnosed with active pulmonary tuberculosis after admission to the intensive care unit (ICU).

Design: New cases of active pulmonary tuberculosis admitted to our critical care unit from January 1999 to January 2006 were identified. Data were collected retrospectively from medical records including demographics, clinical presentation, number of sputum samples, therapy provided and patient outcome.

Setting: Data were collected from the ICU database and microbiology laboratory records.

Patients and participants: Thirty-three patients were diagnosed with active pulmonary tuberculosis. Age was 63±17, and 60.7% were males. Onset of symptoms averaged 17 days prior to presentation (range: 1-90 days), including fever in 51%, cough in 14%, dyspnea in 8%, night sweats in 6%.

Interventions: Twenty-two patients were treated for tuberculosis during hospitalization. The other 11 were not diagnosed during hospitalization and were found later to be culture positive.

Measurements and results: The most common ICU clinical diagnosis was community-acquired pneumonia in 54%, followed by aspiration pneumonia in 3%. Out of 161 tracheal aspirates, only 48 (30%) were AFB stain positive and 80 (69%) were culture positive. Out of 33 patients who had at least one positive culture, only 62% were AFB stain positive. Of the 22 patients treated for tuberculosis during hospitalization; 15 (68%) died. Of the remaining 11 who were not diagnosed during hospitalization 7 (64%) died.

Conclusions: Active pulmonary tuberculosis is common in ICU patients. The diagnosis may be confounded by atypical clinical presentation and the lack of sensitive and rapid diagnostic tests. Considering the impact if misdiagnosis and risk of transmission to health care professionals, clinicians must maintain high level of suspicion and a low threshold for respiratory isolation. Newer and more sensitive tests must be developed and utilized.