• Electronic health records
• Hypertension
• Hypotension
• Knowledgebase
• PairedPheWAS
• Phecode

• Humans
• Hypertension/physiopathology
• Hypertension/genetics
• Phenotype
• Female
• Hypotension/physiopathology
• Hypotension/genetics
• Male
• Middle Aged
• Blood Pressure/physiology
• Electronic Health Records
• Aged
• Adult
• Chronic Disease
• Cohort Studies

• R01 LM010685 NLM NIH HHS
• UL1 TR002243 NCATS NIH HHS

• mechanical ventilation
• risk prediction model
• tuberculosis-destroyed lung

• Humans
• Male
• Female
• Middle Aged
• Retrospective Studies
• Respiration, Artificial/statistics & numerical data
• Aged
• China/epidemiology
• Risk Factors
• Intensive Care Units/statistics & numerical data
• Tuberculosis, Pulmonary/mortality
• Prognosis
• Body Mass Index

• Antituberculous treatment
• Critically ill
• Immunocompromised host
• Infection prevention and control
• Organ support
• Tuberculosis

• Critical care
• Diagnosis of tuberculosis
• Intensive care
• Management of tuberculosis
• Mycobaterium tuberculosis
• Severe tuberculosis
• Tuberculosis

• Mycobacterium tuberculosis
• Hematogenous disseminated tuberculosis
• Metagenomic next-generation sequencing
• Sepsis

• Humans
• Female
• Middle Aged
• Mycobacterium tuberculosis/genetics
• Shock, Septic
• Abscess/diagnosis
• Sepsis/diagnosis
• Tuberculosis, Miliary
• High-Throughput Nucleotide Sequencing
• Respiratory Insufficiency

• 2023jstg047 Chongqing Health Appropriate Technology Extension Project
• 2023jstg047 Chongqing Health Appropriate Technology Extension Project
• 2023jstg047 Chongqing Health Appropriate Technology Extension Project

• Advanced HIV disease
• Ethiopia
• Septic shock
• Spontaneous pneumothorax
• TB related ARDS

• immunocompetent
• pulmonary
• sepsis
• septic shock
• tuberculosis

• acid fast
• bronchiectasis
• malnutrition
• multi-organ failure
• mycobacterium
• pulmonary tuberculosis
• sepsis
• septic shock

• Beijing
• Drug resistance
• Gene mutation
• Isoniazid
• Mycobacterium tuberculosis
• Spoligotype

• diagnostics and management
• disease
• micronanotechnology
• point-of-critical-care biosensors

• Biosensing Techniques
• Critical Care
• Humans
• Microtechnology
• Nanotechnology
• Point-of-Care Systems
• Sepsis/diagnosis

• P41 RR012408 NCRR NIH HHS
• T32 GM135141 NIGMS NIH HHS

• Mycobacterium tuberculosis
• bloodstream infection
• intensive care unit
• sepsis
• septic shock

About 3.4% of the hospitalized tubercular patients need admission to the intensive care unit (ICU). Patients requiring ICU admission had a poor prognosis and high mortality rate (60 vs 25%) as compared to other causes of severe pneumonia. The most common indication for tuberculosis-related ICU admission is acute respiratory failure due to pneumonia or acute respiratory distress syndrome (ARDS) (with or without miliary tuberculosis) followed by septic shock with multiple organ dysfunction, adrenal insufficiency, and neurological involvement, especially tubercular meningitis. Tuberculosis patients who require admission to ICU are mostly immunocompromised [human immunodeficiency virus (HIV) coinfection] and have underlying miliary tuberculosis or disseminated tuberculosis. Pulmonary tuberculosis presenting as ARDS is a rare phenomenon, but a most common cause of admission of tuberculosis patients to ICU. Tuberculous meningitis is the most severe form of tuberculosis with mortality more than 60% and residual neurological disability in 25% cases. Tuberculosis-related septic shock has been found in only 1% of all septic shock patients admitted to ICU. Patients with tuberculosis with refractory shock should be suspected for adrenal insufficiency. A trial of physiologic stress replacement dose of hydrocortisone (200–300 mg) should be given to all critically ill patients with vasopressor-dependent shock after correcting other causes. Diagnosis and treatment of tuberculosis in critically ill patients has various challenges, namely appropriate sample collection, issues with the route of administration, drug absorption, bioavailability, dose modification in hepatic and renal dysfunction, and interaction with other drugs.

How to cite this article: Chaudhry D, Tyagi D. Tuberculosis in Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2):S150–S154.

• Acute respiratory distress syndrome (ARDS)
• Miliary tuberculosis
• Septic shock
• Tuberculous meningitis

• TB and other respiratory infections
• adult intensive care
• infection (gastroenterology)
• tuberculosis

• human immunodeficiency virus
• pharmacokinetics
• treatment
• tuberculosis

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.

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.

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 anti-inflammatory 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.

• Corticosteroids
• Paradoxical reaction
• SIRS
• Tuberculosis

The goal of reducing tuberculosis (TB) mortality in the END TB Strategy can be achieved if TB deaths are considered predictable and preventable. This will require programs to examine and address some key gaps in the understanding of the distribution and determinants of TB mortality and the current model of assessment and care in high burden countries.

Most deaths in high-burden countries occur in the first eight weeks of treatment and in those belonging to the age group of 15–49 years, living in poverty, with HIV infection and/or low body mass index (BMI). Deaths result from extensive disease, comorbidities like advanced HIV disease complicated with other infections (bacterial, fungal, bloodstream), and moderate-severe undernutrition. Most early deaths in patients with TB, even with TB-HIV co-infection, are due to TB itself.

Comprehensive assessment and clinical care are a prerequisite of patient-centered care. Simple independent predictors of death like unstable vital signs, BMI, mid-upper arm circumference, or inability to stand or walk unaided can be used by programs for risk assessment. Programs need to define criteria for referral for inpatient care, address the paucity of hospital beds and develop and implement guidelines for the clinical management of seriously ill patients with TB, advanced HIV disease and severe undernutrition as co-morbidities. Programs should also consider notification and audit of all TB deaths, similar to audit of maternal deaths, and address the issues in delays in diagnosis, treatment, and quality of care.

• Clinical care
• Co-morbidity
• End-tb strategy
• Epidemiology
• Tb mortality
• tuberculosis

As per latest Global TB Report (2018), an estimated 2.2 lakh children get tuberculosis (TB) each year in India and illness constitutes a very high global burden. Here we report an unusual case of a child aged 14 years (female), who presented to Emergency with complaints of cough and restlessness for the past 1 day. Working diagnosis of septic shock was kept and child was started on intravenous ionotropes, vasopressors, and an antibiotic. There was no significant history suggestive of TB. Patient was shifted to PICU and managed for shock accordingly. X-ray lung showed single right-sided cavitatory lesion. Bronchoalveolar lavage was positive for acid fast bacilli, confirming the diagnosis of pulmonary TB. The patient was started on antitubercular drug regimen (ATT) for 6 months and showed significant improvement with complete resolution. Literature was searched for association of septic shock in tubercular patients as a presenting complaint, which is a rare entity.

• Case fatality for tuberculosis septic shock
• Case report
• Tuberculosis and immune reconstitution
• Tuberculosis in intensive care unit
• Tuberculosis septic shock

• AIDS-Related Opportunistic Infections/diagnosis
• AIDS-Related Opportunistic Infections/immunology
• AIDS-Related Opportunistic Infections/microbiology
• AIDS-Related Opportunistic Infections/mortality
• Adult
• Biomarkers/blood
• Cause of Death
• Coinfection
• Female
• HIV Infections/diagnosis
• HIV Infections/immunology
• HIV Infections/mortality
• HIV Infections/virology
• Hospital Mortality
• Host-Pathogen Interactions
• Humans
• Immunocompromised Host
• Inflammation Mediators/blood
• Male
• Middle Aged
• Patient Admission
• Prospective Studies
• Risk Assessment
• Risk Factors
• Sepsis/immunology
• Sepsis/microbiology
• Sepsis/mortality
• South Africa/epidemiology
• Time Factors
• Tuberculosis/diagnosis
• Tuberculosis/immunology
• Tuberculosis/microbiology
• Tuberculosis/mortality

• 098316 Wellcome Trust
• 203135 Wellcome Trust
• 211360/Z/18/Z Wellcome Trust
• FC00110218 Medical Research Council
• 104803 Wellcome Trust
• U01 AI115940 NIAID NIH HHS
• Wellcome Trust
• FC00110218 Wellcome Trust
• 211360 Wellcome Trust
• FC00110218 Cancer Research UK
• South African Medical Research Council
• South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa
• National Research Foundation of South Africa
• UK Medical Research Council
• National Institutes of Health

• TB and other respiratory infections
• global health
• hepatitis and other GI infections
• tropical medicine (infectious disease)

• CAP
• Community-acquired pneumonia
• HAP
• Hospital-acquired pneumonia
• Pneumonia

• Anti-Bacterial Agents/administration & dosage
• Community-Acquired Infections/diagnosis
• Community-Acquired Infections/microbiology
• Community-Acquired Infections/physiopathology
• Community-Acquired Infections/therapy
• Healthcare-Associated Pneumonia/diagnosis
• Healthcare-Associated Pneumonia/microbiology
• Healthcare-Associated Pneumonia/physiopathology
• Healthcare-Associated Pneumonia/therapy
• Humans
• Pneumonia/diagnosis
• Pneumonia/microbiology
• Pneumonia/physiopathology
• Pneumonia/therapy
• Risk Factors

Mycobacterium tuberculosis is the leading cause of bloodstream infection among human immunodeficiency virus (HIV)–infected patients with sepsis in sub-Saharan Africa and is associated with high mortality rates.

We conducted a retrospective study of HIV-infected adults with sepsis at the Mbarara Regional Referral Hospital in Uganda to measure the proportion who received antituberculosis therapy and to determine the relationship between antituberculosis therapy and 28-day survival.

Of the 149 patients evaluated, 74 (50%) had severe sepsis and 48 (32%) died. Of the 55 patients (37%) who received antituberculosis therapy, 19 (35%) died, compared with 29 of 94 (31%) who did not receive such therapy (odds ratio, 1.34; 95% confidence interval [CI], .56–3.18; P = .64). The 28-day survival rates did not differ significantly between these 2 groups (log-rank test, P = .21). Among the 74 patients with severe sepsis, 9 of 26 (35%) who received antituberculosis therapy died, versus 23 of 48 (48%) who did not receive such therapy (odds ratio, 0.58; 95% CI, .21–1.52; P = .27). In patients with severe sepsis, antituberculosis therapy was associated with an improved 28-day survival rate (log-rank test P = .01), and with a reduced mortality rate in a Cox proportional hazards model (hazard ratio, 0.32; 95% CI, .13–.80; P = .03).

Empiric antituberculosis therapy was associated with improved survival rates among patients with severe sepsis, but not among all patients with sepsis.

• Africa
• Mycobacterium tuberculosis
• Uganda
• sepsis

• Asp505Ala
• Gly481Ala
• Multi-drug resistance (MDR) TB
• Semi-multiplex allele specific (MAS) PCR
• gyrB

• adults
• pneumonia
• protocolized care
• sepsis
• sub-Saharan Africa
• tuberculosis

• Arbovirus
• Bacteraemia
• Fever
• Tuberculosis
• Viruses
• Zoonoses

• Africa South of the Sahara/epidemiology
• Disease Management
• Fever/diagnosis
• Fever/epidemiology
• Fever/etiology
• Fever/therapy
• Humans
• Population Surveillance

• BB/J010367/1 Biotechnology and Biological Sciences Research Council
• P30 AI036214 NIAID NIH HHS
• R01 AI121378 NIAID NIH HHS
• R01 TW009237 FIC NIH HHS

• Antitubercular Agents/therapeutic use
• Critical Care
• Critical Illness
• Drug Administration Routes
• Drug Administration Schedule
• Humans
• Tuberculosis/complications
• Tuberculosis/drug therapy

• Drug-resistant tuberculosis
• Infection control
• Intensive care
• Latent tuberculosis
• Multi-drug resistant tuberculosis
• Tuberculosis

Miliary tuberculosis, complicated by ARDS and septic shock, is a rare and lethal presentation of this disease. Here we present a case of such a patient, following which we discuss the management of tuberculosis in the ICU and some of the challenges that may be faced. A young HIV negative female presented to us with an acute history of worsening shortness of breath on a background of weight loss, nonproductive cough, and fever. CXR and CT scan showed bilateral miliary type opacities and the patient was admitted to the hospital. Within forty-eight hours of admission she became hypoxemic and was intubated and transferred to the ICU. There she experienced worsening organ dysfunction and developed circulatory shock. Despite escalating doses of noradrenaline, she continued to decline and died before specific anti-TB treatment could be started. Timely diagnosis and treatment initiation are the keys to improving outcomes in critically ill TB patients. However there are many challenges in doing so, especially in a general ICU located in a country with a low TB incidence.

Solid organ transplant recipients have an elevated risk of tuberculosis (TB) with high mortality. Data about TB in this population in the United States is sparse. We present four cases of active tuberculosis in kidney transplant recipients at our center. All patients had possible TB exposure prior to transplant and all were diagnosed with active TB within the first year of transplant. Disseminated TB was seen in half of the patients with extra-pulmonary TB being more common affecting lymph nodes, pericardium, and the kidney allograft. Delay in diagnosis from onset of symptoms ranged from fifteen days to two months. Two patients died from TB. TB is a largely preventable and curable disease. However, challenges remain in the diagnosis due to most recipients presenting with atypical symptoms. Physicians should maintain a high degree of suspicion for TB to promptly diagnose and treat post-transplant thereby minimizing complications. A review of the literature including the epidemiology, pathogenesis, clinical presentation, diagnosis and treatment options are discussed.

• Mycobacterium tuberculosis
• Kidney transplant
• Disseminated disease
• Tuberculosis

• Osteoporosis
• Osteoporotic fracture
• Taiwan
• Tuberculosis

• Adult
• Aged
• Case-Control Studies
• Comorbidity
• Databases, Factual
• Endemic Diseases
• Female
• Humans
• Incidence
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Osteoporosis/epidemiology
• Osteoporosis/microbiology
• Osteoporotic Fractures/epidemiology
• Osteoporotic Fractures/microbiology
• Risk Factors
• Socioeconomic Factors
• Taiwan/epidemiology
• Tuberculosis/complications
• Tuberculosis/epidemiology

• Diagnostic Tests, Routine/methods
• HIV Infections/complications
• Humans
• Immunocompromised Host
• Radiography, Thoracic
• Tomography, X-Ray Computed
• Tuberculosis, Pleural/diagnosis
• Tuberculosis, Pleural/drug therapy
• Tuberculosis, Pleural/pathology
• Tuberculosis, Pleural/physiopathology
• Tuberculosis, Pulmonary/diagnosis
• Tuberculosis, Pulmonary/drug therapy
• Tuberculosis, Pulmonary/pathology
• Tuberculosis, Pulmonary/physiopathology

• acute respiratory distress syndrome
• human immunodeficiency virus
• intensive care unit
• pulmonary tuberculosis

• AIDS
• highly active antiretroviral therapy
• human immunodeficiency virus

• Africa
• Monitoring
• Mortality
• Resuscitation
• Severe sepsis
• Uganda

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Odds Ratio
• Postoperative Complications/etiology
• Taiwan
• Tuberculosis, Pulmonary/complications
• Young Adult

• africa
• sepsis
• goal-directed therapy
• zambia
• tuberculosis

• Adult
• Anti-Bacterial Agents/therapeutic use
• Blood Transfusion/methods
• Combined Modality Therapy
• Critical Care/methods
• Developing Countries
• Dopamine/therapeutic use
• Emergency Service, Hospital
• Female
• Fluid Therapy/methods
• Hospital Mortality
• Humans
• Intensive Care Units
• Male
• Middle Aged
• Pilot Projects
• Risk Assessment
• Sepsis/diagnosis
• Sepsis/mortality
• Sepsis/therapy
• Shock, Septic/diagnosis
• Shock, Septic/mortality
• Shock, Septic/therapy
• Survival Analysis
• Treatment Outcome
• Zambia

• D43 TW009337 FIC NIH HHS
• R24 TW007988 FIC NIH HHS
• UL1 TR000445 NCATS NIH HHS

The advent of modern antimicrobial therapy following the discovery of penicillin during the 1940s yielded remarkable improvements in case fatality rate of serious infections including septic shock. Since then, pathogens have continuously evolved under selective antimicrobial pressure resulting in a lack of significant improvement in clinical effectiveness in the antimicrobial therapy of septic shock despite ever more broad-spectrum and potent drugs. In addition, although substantial effort and money has been expended on the development novel non-antimicrobial therapies of sepsis in the past 30 years, clinical progress in this regard has been limited. This review explores the possibility that the current pathophysiologic paradigm of septic shock fails to appropriately consider the primacy of the microbial burden of infection as the primary driver of septic organ dysfunction. An alternate paradigm is offered that suggests that has substantial implications for optimizing antimicrobial therapy in septic shock. This model of disease progression suggests the key to significant improvement in the outcome of septic shock may lie, in great part, with improvements in delivery of existing antimicrobials and other anti-infectious strategies. Recognition of the role of delays in administration of antimicrobial therapy in the poor outcomes of septic shock is central to this effort. However, therapeutic strategies that improve the degree of antimicrobial cidality likely also have a crucial role.

• antibiotic
• antimicrobial
• combination therapy
• infection
• life-threatening infection
• pharmacokinetics
• sepsis
• septic shock
• survival