Tuberculosis in the ICU

  • Hulya Sungurtekin


Tuberculosis remains a significant public health problem worldwide. Patients with suspected or definite tuberculosis may require intensive care for a variety of reasons. The majority of patients with pulmonary tuberculosis required intensive care for treating acute respiratory failure. High mortality was observed among patients with active tuberculosis and respiratory failure that required mechanical ventilation. The second most frequent reason for admission to intensive care was severe sepsis/septic shock; most of these patients presented with multiple organ failure, and they displayed higher mortality than patients admitted to intensive care for other reasons. Tuberculosis is a treatable disease, and an active approach with immediate intervention is required for treating patients that are critically ill. Delays in starting therapy can be associated with worse survival. This review describes the reasons that patients with tuberculosis may need intensive care, and we discuss the diagnosis and management of these patients in an intensive care environment.


Tuberculosis Intensive care Miliary tuberculosis Pulmonary tuberculosis Tuberculosis meningitis Tuberculosis outcome Tuberculosis diagnosis 


  1. 1.
    Centers for Disease Control and Prevention (CDC). Tuberculosis. Data and Statistics. Accessed 5 June 2017.
  2. 2.
    WHO, Global tuberculosis report 2016. Accessed 5 June 2017.
  3. 3.
    Erbes R, Oettel K, Raffenberg M, Mauch H, Schmidt-Ioanas M, Lode H. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care. Eur Respir J. 2006;27(6):1223–8.CrossRefGoogle Scholar
  4. 4.
    Duro RP, Figueiredo Dias P, Ferreira AA, Xerinda SM, Lima Alves C, Sarmento AC, Dos Santos LC. Severe tuberculosis requiring intensive care: a descriptive analysis. Crit Care Res Pract. 2017;2017:9535463, 9 pages.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Pablos-M’endez A, Sterling TR, Frieden TR. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. J Am Med Assoc. 1996;276(15):1223–8.CrossRefGoogle Scholar
  6. 6.
    Lanoix J-P, Gaudry S, Flicoteaux R, Ruimy R, Wolff M. Tuberculosis in the intensive care unit: a descriptive analysis in a low-burden country. Int J Tuberc Lung Dis. 2014;18(5):581–7.CrossRefGoogle Scholar
  7. 7.
    Ryu YJ, Koh WJ, Kang EH, Suh GY, Chung MP, Kim H, Kwon OJ. Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure. Respirology. 2007;12(3):406–11.CrossRefGoogle Scholar
  8. 8.
    Balkema CA, Irusen EM, Taljaard JJ, Koegelenberg CFN. Tuberculosis in the intensive care unit: a prospective observational study. Int J Tuberc Lung Dis. 2014;18(7):824–30.CrossRefGoogle Scholar
  9. 9.
    Cavallazzi R, Wiemken T, Christensen D, Peyrani P, Blasi F, Levy G, Aliberti S, Kelley R, Ramirez J, Community-Acquired Pneumonia Organization (CAPO) Investigators. Predicting Mycobacterium tuberculosis in patients with community-acquired pneumonia. Eur Respir J. 2014;43(1):178–84.CrossRefGoogle Scholar
  10. 10.
    Geiss HK, Feldhues R, Niemann S, Nolte O, Rieker R. Landouzy septicemia (sepsis tuberculosa acutissima) due to Mycobacterium microti in an immunocompetent man. Infection. 2005;33(5–6):393–6.CrossRefGoogle Scholar
  11. 11.
    Chakravarty C, Burman S. VA-ECMO in Landouzy sepsis or tubercular septic shock. J Anesth Crit Care Open Access. 2017;8(1):00289.Google Scholar
  12. 12.
    Pecego AC, Amancio RT, Ribeiro C, Mesquita EC, Medeiros DM, Cerbino J, Grinsztejn B, Bozza FA, Japiassu AM. Six-month survival of critically ill patients with HIV-related disease and tuberculosis: a retrospective study. BMC Infect Dis. 2016;16:270.CrossRefGoogle Scholar
  13. 13.
    Gary J, Cohn D. Tuberculosis and HIV Coinfection. Semin Respir Crit Care Med. 2013;34(01):032–43.CrossRefGoogle Scholar
  14. 14.
    Japiassú AM, Amâncio RT, Mesquita EC, Medeiros DM, Bernal HB, Nunes EP, et al. Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients. Crit Care. 2010;14(4):R152.CrossRefGoogle Scholar
  15. 15.
    Crump JA, Ramadhani HO, Morrissey AB, Saganda W, Mwako MS, Yang LY, et al. Bacteremic disseminated tuberculosis in sub-saharan Africa: a prospective cohort study. Clin Infect Dis. 2012;55(2):242–50.CrossRefGoogle Scholar
  16. 16.
    Hui C, Wu CL, Chan MC, Kuo IT, Chiang CD. Features of severe pneumonia in patients with undiagnosed pulmonary tuberculosis in an intensive care unit. J Formos Med Assoc. 2003;102:563–9.PubMedGoogle Scholar
  17. 17.
    Hashemian SM, Tabarsi P, Karam MB, Kahkouee S, Marjani M, Jamaati H, Shekarchi N, Mohajerani SA, Velayati AA. Radiologic manifestations of pulmonary tuberculosis in patients of intensive care units. Int J Mycobacteriol. 2015;4(3):233–8.CrossRefGoogle Scholar
  18. 18.
    Agarwal R, Gupta D, Handa A, Aggarwal ANR. Noninvasive ventilation in ARDS caused by Mycobacterium tuberculosis: report of three cases and review of literature. Intensive Care Med. 2005;31(12):1723–4.CrossRefGoogle Scholar
  19. 19.
    Flores-Franco RA, Olivas-Medina DA, Pacheco-Tena CF, Duque-Rodríguez J. Immunoadjuvant therapy and noninvasive ventilation for acute respiratory failure in lung tuberculosis: a case study. Case Rep Pulmonol. 2015;2015:283867. Epub 2015 Jul 27.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, Chaisson LH, Chaisson RE, Daley CL, Grzemska M, Higashi JM, Ho CS, Hopewell PC, Keshavjee SA, Lienhardt C, Menzies R, Merrifield C, Narita M, O'Brien R, Peloquin CA, Raftery A, Saukkonen J, Schaaf HS, Sotgiu G, Starke JR, Migliori GB, Vernon A. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016;63(7):e147–95.CrossRefGoogle Scholar
  21. 21.
    Critchley JA, Young F, Orton L, Garner P. Corticosteroids for prevention of mortality in people with tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):223–37.CrossRefGoogle Scholar
  22. 22.
    Jensen PA, Lambert LA, Iademarco MF, et al. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. 2005;54:1–141.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Levy H, Kallenbach JM, Feldman C, Thorburn JR, Abramowitz JA. Acute respiratory failure in active tuberculosis. Crit Care Med. 1987;15:221–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Hulya Sungurtekin
    • 1
  1. 1.Department of Anesthesiology, School of MedicinePamukkale UniversityDenizliTurkey

Personalised recommendations