Tuberculous pneumonia-induced severe ARDS complicated with DIC in a female child: a case of successful treatment.

BACKGROUND: Tuberculous (TB) pneumonia can induce acute respiratory distress syndrome (ARDS). Although TB pneumonia is one of the causes of disease and death among children worldwide, the literature on TB pneumonia-induced ARDS is limited. We report herein on the successful treatment of a two-year-old female child with TB pneumonia-induced severe ARDS complicated with disseminated intravascular coagulation (DIC). CASE PRESENTATION: A two-year-old Vietnamese female child with sustained fever and cough for 20 days was transferred to our hospital. She had severe dyspnea and a chest X-ray showed bilateral infiltration without findings of heart failure. After tracheal intubation, her oxygenation index (OI) and PaO2/FiO2 (PF) ratio were 29 and 60 mmHg, respectively. Mycobacterium tuberculosis was detected by real-time polymerase chain reaction (rPCR) assay of tracheal lavage fluid. She was diagnosed as having severe ARDS that developed from TB pneumonia. Anti-tuberculous therapy and cardiopulmonary support were started. However, her respiratory condition deteriorated despite treatment with high-frequency oscillating ventilation (HFO), vasopressor support, and 1 g/kg of immunoglobulin. On the third day after admission, her International Society on Thrombosis and Hemostasis DIC score had increased to 5. Recombinant human soluble thrombomodulin (rTM) was administered to treat the DIC. After the administration of rTM was completed, OI gradually decreased, after which the mechanical ventilation mode was changed from HFO to synchronized intermittent mandatory ventilation. The DIC score also gradually decreased. Plasma levels of soluble receptor for advanced glycan end products (sRAGE) and high mobility group box 1 (HMGB-1), which are reported to be associated with ARDS severity, also decreased. In addition, inflammatory biomarkers, including interferon-gamma (IFN-γ) and interleukin-6 (IL-6), decreased after the administration of rTM. Although severe ARDS (P/F ratio ≦ 100 mmHg) continued for 19 days, the patient's OI and P/F ratio improved gradually, and she was extubated on the 27th day after admission. The severe ARDS with DIC was successfully treated, and she was discharged from hospital on day 33 post-admission. CONCLUSIONS: We successfully treated a female child suffering from TB pneumonia-induced severe ARDS complicated with DIC using multimodal interventions. (338/350).

Disseminated tuberculosis with acute respiratory distress syndrome lacking granuloma formation in the lung.

A 66-year-old woman, who had been treated with systemic corticosteroids for four months for vasculitis of unknown etiology, was referred to our department due to a fever, dyspnea and patchy ground-glass opacities on chest computed tomography. As transbronchial biopsy specimens were suggestive of interstitial pneumonia, the prescribed dose of corticosteroids was increased. However, the patient developed pyrexia and presented diffuse ground-glass attenuation in the lungs bilaterally. Antituberculous drugs were administered because a previous blood interferon-gamma release assay was positive, however, the patient died of severe respiratory failure within several days, and cultures of her blood, urine and bone marrow posthumously revealed Mycobacterium tuberculosis. An autopsy revealed multiple foci of air-space pneumonia containing numerous acid-fast bacilli without granuloma formation, accompanied by diffuse alveolar damage. An immunosuppressive condition might inhibit air-space pneumonia to become granulomatous inflammation as an initial stage of pulmonary tuberculosis.

Pneumonia caused by Mycobacterium tuberculosis.

Tuberculosis (TB) is one of the top ten leading causes of death worldwide. The causative agent of TB is Mycobacterium tuberculosis. Acute tuberculous pneumonia (TP) is an acute form of pulmonary TB. However, acute TP and non-tuberculous community-acquired pneumonia can be easily confused, resulting in deterioration of TP due to delayed treatment. Therefore, rapid and accurate diagnosis of acute TP is crucial in order to stop the transmission of TB. Moreover, development of new diagnostic tools (technologies and approaches), and flexible application of different therapy schemes will help to reduce the incidence of TP and promote the goal of ending the TB epidemic.

Características epidemiológicas y radiológicas en un grupo de pacientes con neumonía tuberculosa sin inmunodepresión o comorbilidades / Epidemiological and Radiological Characteristics of a Group of Patients with Tuberculous Pneumonia without Immunosuppression or Comorbidities

La neumonía tuberculosa es una patología poco frecuente, descripta mayormente en pacientes con inmunosupresión o comorbilidades, como alcoholismo o diabetes, con una presentación radiológica similar a la neumonía bacteriana, lo cual puede dar lugar a retrasos en el diagnóstico. En este trabajo, se incluyeron pacientes con diagnóstico de tuberculosis e imagen radiológica de consolidación en los campos pulmonares inferiores y sin comorbilidades asociadas. En el transcurso de tres años identificamos veinticinco pacientes con estos criterios entre 628 casos de tuberculosis pulmonar evaluados. No encontramos relación con el sexo, y resulta más frecuente la afectación del lóbulo inferior derecho (84%) que el izquierdo.

Tuberculous pneumonia is a rare disease, mostly described in patients with immunosup pression or comorbidities such as alcoholism or diabetes, with a radiological presentation similar to bacterial pneumonia, which can lead to delays in diagnosis. Patients with a diagnosis of tuberculosis and radiological image of consolidation in the lower lung fields and without associated comorbidities were included in this study. Over the course of 3 years, we identified 25 patients with these criteria among 628 cases of pulmonary tuberculosis evaluated. We found no relationship with sex, with the right lower lobe be ing affected more frequently (84%) than the left.

Pneumonia tuberculosa: relato de caso / Tuberculous pneumonia: case report / Neumonía tuberculosa: reporte de caso

A tuberculose é uma doença infecciosa causada pelo Mycobacterium tuberculosis muito disseminada no Brasil. Tem preferência pelo acometimento pulmonar, embora vários outros órgãos possam ser afetados, como vasos linfáticos, trato geniturinário, ossos, articulações, sistema nervoso central, trato gastrointestinal e pericárdio. A pneumonia tuberculosa é uma forma rara, que se apresenta com consolidação alveolar, principalmente em lobo superior, podendo mimetizar um quadro de pneumonia pneumocócica. O objetivo deste ensaio é relatar o caso clínico de um indivíduo do sexo masculino com diagnóstico de pneumonia tuberculosa no Hospital Geral Roberto Santos (HGRS) e fazer uma breve revisão da literatura sobre o tema. O método utilizado para isso será o relato de caso clínico, com informações obtidas por meio de revisão de dados contidos em prontuário médico. Os resultados obtidos foram: paciente do sexo masculino, 19 anos, previamente hígido, não tabagista, natural de Recife, procedente de Salvador, admitido em agosto de 2019 no serviço de emergência do HGRS, com história de tosse produtiva de secreção amarelada, febre não mensurada e calafrios. O relato de caso descrito mostra uma apresentação atípica, rara e pouco comum de pneumonia tuberculosa/tuberculose pulmonar. A procura por diagnósticos diferenciais em quadros com resposta ruim à terapêutica inicialmente instituída é fundamental para evitar atrasos entre a realização do diagnóstico correto e a introdução das devidas medidas terapêuticas.

Tuberculosis is a highly prevalent infectious disease in Brazil, caused by Mycobacterium tuberculosis. Despite mostly affecting the lungs, it may also affect other organs, such as lymphatic vessels, genitourinary tract, bones, joints, central nervous system, gastrointestinal tract, and pericardium. A rare form of the disease, tuberculous pneumonia presents with alveolar consolidation, especially in the upper lobe, possibly mimicking pneumococcal pneumonia. This study sought to report the clinical case of a male individual diagnosed with Tuberculous Pneumonia at the Hospital Geral Roberto Santos, as well as to perform a brief literature review of subject. The study was conducted with data collected from the medical records of a male patient aged 19 years old, previously healthy, non-smoker, born in Recife and living in Salvador, admitted in August 2019 to the emergency service of Hospital Geral Roberto Santos with a history of productive cough yellowish sputum, unmeasured fever, and chills. The case report here described shows an atypical, rare, and uncommon presentation of Tuberculous Pneumonia/Pulmonary Tuberculosis. To avoid delays between the correct diagnosis and the introduction of the respective therapeutic measures, health professionals should search for differential diagnoses in conditions with poor response to the initially instituted therapy.

La tuberculosis es una enfermedad infecciosa causada por Mycobacterium tuberculosis muy prevalente en Brasil. Tiene preferencia por la afectación pulmonar, aunque pueden estar implicados muchos otros órganos, como vasos linfáticos, tracto genitourinario, huesos, articulaciones, sistema nervioso central, tracto gastrointestinal y pericardio. La neumonía tuberculosa es una forma rara, que se presenta con consolidación alveolar, especialmente en el lóbulo superior, que puede simular un cuadro de neumonía neumocócica. El objetivo de este ensayo es informar el caso clínico de un varón diagnosticado de Neumonía Tuberculosa en el Hospital Geral Roberto Santos y realizar una breve revisión de la literatura sobre el tema. El método utilizado para ello será elreporte de caso clínico con información obtenida mediante revisión de datos contenidos en historias clínicas. Los resultados obtenidos fueron: paciente varón de 19 años, previamente sano, no fumador, nacido en Recife, residente en Salvador, ingresado en agosto de 2019 en el servicio de urgencias del Hospital Geral Roberto Santos, con antecedente de tos productiva amarillenta, fiebre no medida y escalofríos. El reporte de caso aquí descrito muestra una presentación atípica, rara y poco común de neumonía tuberculosa/tuberculosis pulmonar. La búsqueda de diagnósticos diferenciales en condiciones con mala respuesta a la terapia inicialmente instituida es fundamental para evitar retrasos entre el diagnóstico correcto y la introducción de las respectivas medidas terapéuticas.

Caracterización clinicoepidemiológica de adolescentes con el síndrome de inmunodeficiencia adquirida en aldeas de Guinea Ecuatorial / Clinical and epidemiological characterization of adolescents with acquired immunodeficiency syndrome in small villages in Equatorial Guinea

Se realizó un estudio descriptivo, longitudinal y prospectivo de 480 adolescentes con el síndrome de inmunodeficiencia adquirida, pertenecientes a 2 aldeas de Guinea Ecuatorial, atendidos en un puesto de salud desde julio de 2005 hasta enero de 2007, a fin de caracterizarles según variables clínicas y epidemiológicas. Entre los principales resultados sobresalieron: las edades de 15 a 17 años, el sexo femenino y los adolescentes en estadios III y IV de la infección. La candidiasis bucal, las neumonías bacterianas y la neumonía por Pneumocystis carinii constituyeron las afecciones asociadas más frecuentes, las 2 últimas de las cuales, además de la neumonía tuberculosa, devinieron las principales causas de muerte

A descriptive, longitudinal and prospective study was carried out in 480 adolescents with acquired immunodeficiency syndrome, belonging to two small villages in Equatorial Guinea, attended in a health post from July 2005 to January 2007, in order to characterize them according to clinical and epidemiological variables. Among the main results were ages between 15 and 17 years, female sex and adolescents in III and IV stages of infection. Oral candidiasis, bacterial pneumonias and pneumonia by Pneumocystis carinii were the most frequent associated conditions, the two latter, besides tuberculous pneumonia, were the main causes of death

Motivos de hospitalización en pacientes con tuberculosis pulmonar en un hospital de referencia / Reasons for medical admission in patients with pulmonary tuberculosis in a referral institute

Objetivo: Determinar la prevaíencia de complicaciones torácicas en pacientes con tuberculosis pulmonar hospitalizados en el Instituto Nacional de Enfermedades Respiratorias (INER). Lugar del estudio: INER, centro de tercer nivel y referencia dedicado a la atención médica especializada, docencia e investigación de enfermedades respiratorias. Material y métodos: Se realizó un estudio retrospectivo con la revisión de los expedientes clínicos de pacientes con tuberculosis pulmonar ingresados al INER, en un período que comprendió del 1 de julio al 31 de diciembre de 2003. Resultados: De los 124 pacientes con tuberculosis pulmonar que acudieron al INER durante el período de estudio, 62.9% (78/124) fueron hospitalizados; 44.9% (35/78) del sexo masculino; mediana de edad, 44.5 años (rango 16-78); el diagnóstico bacteriológico se hizo por baciloscopía en 51.3% (40/78); sólo por cultivo, 5.1% (4/78) y por baciloscopía y cultivo, 43.6% (34/78). Del total de pacientes, 66.6% (52/78) se clasificaron en la categoría I de la Organización Mundial de la Salud. La prevaíencia de diabetes mellitus fue 43.7% (31/78). Los motivos de hospitalización fueron: 46.2% (36/78) para diagnóstico; hemoptisis, 34.6% (27/78); infecciones, 5.2% (4/78) y otros motivos, 14.0% (11/78). Presentaron bronquiectasias, 85.7% (66/78); neumonía, 6.4% (5/78); neumonía por Mycobacterium tuberculosis, 5.1% (4/78); empierna, 5.1% (4/78); fístula broncopleural, 3.9% (3/78); aspergiloma, 2.6% (2/78); compresión tráqueo-bronquial, 1.3% (l/78) y fibrotórax, 12.8% (10/78). Conclusiones: Los pacientes hospitalizados en el INER por tuberculosis pulmonar manifestaron una elevada frecuencia de complicaciones, especialmente de bronquiectasias y hemoptisis. Casi 44% de los pacientes presentó diabetes mellitus; uno de cada dos fue hospitalizado para diagnóstico.

Purpose: To determine the prevalence of thoracic complications in hospitalized patients with pulmonary tuberculosis. Setting: National referral hospital for the care, teaching and investigation of respiratory diseases. Material and methods: This study is based on the retrospective analysis of pulmonary tuberculosis patients admitted from July 1 to December 31, 2003 and was conducted at The National Institute of Respiratory Diseases (INER), Mexico. Results: Seventy eight patients with pulmonary tuberculosis were included in the six month period; 35 (44.9%) were male; the bacteriological diagnosis was done by sputum smear in 51.3% (40/78), culture in 5.1% (4/78) and sputum smear and culture in 43.6% (34/78). Patients were classified as WHO category I in 66.7% (52/78); 43.7% had diabetes mellitus (31/78). Admission causes: for diagnosis in 46.2% (36/78); hemoptysis in 34.6% (27/78); infection in 5.2% (4/78); other causes in 14.0% (11/78); bronchiectasis were present in 85.7% (66/ 77); pneumonia in 6.4% (5/78); Mycobacterium tuberculosis pneumonia in 5.1% (4/78); empyema in 5.1% (4/78); bronchopleural fistula in 3.9% (3/ 78); aspergilloma in 2.6% (2/78); tracheobronchial obstruction in 1.3% (1/78); fibrothorax in 12.8% (10/78). Conclusions: Hospitalized pulmonary tuberculosis patients show an elevated rate of pulmonary complications. Almost half had diabetes mellitus; almost half were hospitalized for diagnosis.