Tuberculosis-Associated Septic Shock: A Case Series.

Tuberculosis septic shock (TBSS) is a rare diagnosis due to inherent diagnostic difficulty or attribution to alternate causes. We report six cases of TBSS, along with comorbidities, clinical characteristics, hospital course, and in-hospital outcomes. All patients were middle-aged, with a median age of 54.5 years (interquartile range (IQR): 47-62). Four patients were males, whereas two were females. Majority (n = 4, 66.7%) of patients had comorbidities. Diabetes mellitus (n = 3, 50%), systemic hypertension (n = 2, 33.3%), and chronic obstructive pulmonary disease (n = 1, 16.7%) were the reported comorbidities in included patients. Median Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission was 12 (IQR: 12-16). All patients had a microbiologic diagnosis of tuberculosis (TB). Four patients (66.7%) had respiratory secretions positive for Mycobacterium tuberculosis (MTB) by acid-fast bacilli (AFB) smear or cartridge-based nucleic acid amplification test (CBNAAT), two had sputum positivity, one had induced sputum positivity, whereas another had bronchoalveolar lavage specimen positive for MTB. One patient had lymph node aspirate positivity, and another had chest wall abscess positive for MTB. All had drug-sensitive TB. Five patients could be prescribed all four primary antitubercular drugs; one patient had deranged liver enzymes, requiring initiation of modified antitubercular therapy (ATT). Five patients were discharged successfully, whereas one patient died during the hospital stay. In-hospital mortality was 16.7%.

Initiation of MDR TB treatment: is hospitalization worth?

BACKGROUND: The treatment for MDR TB is quite prolonged and associated with adverse effects and hence costly. AIM: The aim of study was to study the side-effects of reserve line drugs developing in initial seven days of starting therapy, so as to weigh the need for admission for initiation of treatment against heavy economic burden by admission of huge number of MDR TB patients, and to identify the factors which may have an effect on the number of patients developing side-effects METHODS: All MDR TB patients (930) admitted during study period, who were initiated on Cat IV treatment for MDR TB under RNTCP were questioned daily for any side-effects throughout the day, during initial seven days of treatment. RESULTS: On day one, 342 (36.8%) patients developed side-effects, on 2nd day 456 (49%), on day 3 356 (38.3 %), on fourth day 257 (27.6%), then on fifth day only 172 (18.5 %) patients respectively had reported side-effects. Further decline of side-effects was reported on sixth day 94(10.1%) and seventh day 39(4.2%). Number of events also decreased from 669 on dayl and 965 on day 2, to only 61 on day 7 of treatment. Most of the patients had nausea, vomiting, pain abdomen, restlessness, dizziness, insomnia and headache. Patients with low Hemoglobin had more side-effects from day 2 onwards (p<0.05).Age, BMI, gender and co-morbidities had no significant effect on side-effects in these patients. CONCLUSION: Many patients report side-effects initially on treatment, which gradually decrease from day 4 onwards , so hospitalization for atleast seven days during initiation of Cat IV may not be required in all the patients.

Tuberculosis pneumonia as a primary cause of respiratory failure--report of two cases.

Tuberculosis (TB) is one of the treatable diseases rarely causing Acute Respiratory Failure (ARF). Hypoxic respiratory failure is often fatal in miliary tuberculosis and acute tuberculous bronchopneumonia. We describe two patients of tuberculous pneumonia with ARF who were successfully treated with early appropriate anti-tuberculosis therapy.