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

Abstract

BackgroundTuberculosis is one of the infectious diseases with the highest mortality worldwide, and also results in high costs and periods of disability. Thus, it is a priority to make timely diagnoses at the Primary Care level, with the aim of initiating early treatments and reducing transmission. MethodThis descriptive observational study included a series of cases of 43 patients with a confirmed diagnosis of tuberculosis after admission to intensive care unit (ICU) between 2012 and 2016. The objective of this study was to describe the sociodemographic, epidemiological, and clinical characteristics of this group of patients. ResultsThe age range was between 21 and 80 years; there was a predominance of male gender (53.5%), those affiliated to the subsidised health regime (90.7%), homeless people (18.6%), and those with drug dependence (35%). The main cause of admission was respiratory failure (65.2%), followed by neurological deterioration (18.6%). Almost two-thirds (65%) of the cases had pulmonary tuberculosis exclusively, and 35% had extrapulmonary tuberculosis. Furthermore, 76.7% of patients had co-infection, with human immunodeficiency virus (HIV) being the most frequent (48.8%), followed by pneumonia (34.9%). Moderate to severe malnutrition was documented in 79% of cases, and anemia was found in 95.3%. The mortality rate during the stay in ICU was 46.5%, with prevalence of male gender and prolonged stay (an average of 19 days). ConclusionsIn this case series, there was a predominance of the active working population, those with drug dependence, homeless people, those who were co-infected with HIV, and those with hypoalbuminaemia, anemia, and malnutrition. In addition, around half of the patients died during hospital admission. They had septic shock, an ICU stay and ventilatory support greater than or equal to 8 days. This reflects the need to carry out studies evaluating public health strategies for the early detection of cases in groups of patients with the described characteristics, as well as the importance of always considering tuberculosis as a diagnostic possibility in the ICU.