Tuberculosis in Critical Care

Deepanjali, Surendran; Kadhiravan, Tamilarasu

Although tuberculosis (TB) figures among the top 10 causes of mortality globally, it is rather infrequently encountered in the intensive care unit (ICU) setting even in countries where TB is widely prevalent. Patients with TB constitute less than 2% of total ICU admissions (Muthu et al. 2018; Frame et al. 1987). Notwithstanding, these patients pose considerable challenges in terms of timely diagnosis, treatment, and infection control. Patients with clinically severe forms of TB may require admission to the ICU. Studies from various settings indicate that a broad range of 1–25% of patients with active TB require ICU admission (Patel et al. 2017; Tsai et al. 2008; Levy et al. 1987; Lui et al. 2014; Eveloff et al. 1994; Rao et al. 1998; Silva et al. 2010). The most common reason for transferring a patient with active TB to the ICU is acute respiratory failure (ARF) (Muthu et al. 2018; Frame et al. 1987; Zahar et al. 2001; Valade et al. 2012). Other common indications include mycobacterial septic shock and multiorgan dysfunction syndrome (MODS). However, in some settings, TB meningitis is the most common reason for ICU admission among TB patients. About 40% of patients with TB meningitis would have concomitant pulmonary disease. Less common indications could be massive hemoptysis, pericardial effusion causing cardiac tamponade, Addisonian crisis, airway obstruction in laryngeal TB, disseminated intravascular coagulation (DIC), and seizures caused by tuberculomas in the brain. Importantly, TB patients may also experience acute liver failure due to hepatotoxic drugs and rarely acute renal failure, mainly rifampicin-induced (Hagan and Nathani 2013) (Table 16.1).