Mycobacterial Sepsis and Multiorgan Failure Syndrome

  • S. Jog
  • B. Pawar
  • D. Patel
Part of the Annual Update in Intensive Care and Emergency Medicine 2011 book series (AUICEM, volume 1)


Tuberculosis (TB) is a global disease with high prevalence in developing countries. According to the World Health Organization (WHO) fact sheet 2009, more than 2 billion (equal to one third of world’s population) people are infected with TB bacilli. Of the cases detected, 5 % were cases of multi-drug resistant TB. Admission to a critical care unit is not required in the majority of cases. However, TB sepsis is a rapidly fatal disease that requires intensive care unit (ICU) admission and management and represents a big diagnostic and therapeutic challenge.


Pleural Fluid Nucleic Acid Amplification Drug Susceptibility Testing Drotrecogin Alfa Nucleic Acid Amplification Test 
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  1. 1.
    Bridges DA, Bedimo RG (2006) Severe tuberculosis sepsis in an immunocompetent patient Am J Med 119: e11–e14PubMedCrossRefGoogle Scholar
  2. 2.
    Alvarez S, Melale WR (1984) Extra pulmonary tuberculosis revisited: a review of experience at Boston and other hospitals. Medicine (Baltimore) 64: 25–55Google Scholar
  3. 3.
    Sime PJ, Chilvers ER, Leitch AG (1994) Miliary tuberculosis in Edinburgh — a comparison between 1984–1992 and 1954–1967. Respir Med 88: 609–611PubMedCrossRefGoogle Scholar
  4. 4.
    Moreno C, Mehlert A, Lamb J (1988) The inhibitory effects of mycobacterial lipoarabino-mannan and polysaccharides upon polyclonal and monoclonal human T cell proliferation. Clin. Exp Immunol 74: 206–210PubMedGoogle Scholar
  5. 5.
    Federmann M., Kley HK (1990). Miliary tuberculosis after extracorporeal shock-wave lithotripsy. N Engl J Med 323: 1212PubMedGoogle Scholar
  6. 6.
    Yekanath H, Gross PA, Vitenson JH (1980) Miliary tuberculosis following uretral cathete-risation. Urology 16: 197–198PubMedCrossRefGoogle Scholar
  7. 7.
    Ramesh J, Banait GS, Ormerod LP (2008) Abdominal tuberculosis in a district general hospital: a retrospective review of 86 cases. QJM 101: 189–195PubMedCrossRefGoogle Scholar
  8. 8.
    Maartens G; Willcox PA; Benatar SR (1990) Miliary tuberculosis: rapid diagnosis, hematologic abnormalities, and outcome in 109 treated adults. Am J Med 89: 291–296PubMedCrossRefGoogle Scholar
  9. 9.
    Hunt BJ, Andrews V, Pettingale KW (1987) The significance of pancytopenia in miliary tuberculosis. Postgrad Med J 63: 801–804PubMedCrossRefGoogle Scholar
  10. 10.
    Pai M, Zwerling A, Menzies D (2008) Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med 149: 177–184PubMedGoogle Scholar
  11. 11.
    Kobashi Y, Fukuda M, Yoshida K, Oka M (2007) An indeterminate QuantiFERON TB-2G response for miliary tuberculosis, due to severe pancytopenia. J Infect Chemother 13: 414–417PubMedCrossRefGoogle Scholar
  12. 12.
    Conde MB, Soares SL, Mello FC, et al (2000) Comparison of sputum induction with fiberoptic bronchoscopy in the diagnosis of tuberculosis: experience at an acquired immune deficiency syndrome reference center in Rio de Janeiro, Brazil. Am J Respir Crit Care Med 162: 2238–2240PubMedGoogle Scholar
  13. 13.
    Steingart KR, Henry M, Ng V, et al (2006) Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis 6: 570–581PubMedCrossRefGoogle Scholar
  14. 14.
    Stender H, Mollerup TA, Lund K, et al (1999) Direct detection and identification of Mycobacterium tuberculosis in smear positive sputum samples by fluorescence in situ hybridization (FISH) using peptide nucleic acid (PNA) probes. Int J Tubercl Lung Dis 3: 830–837Google Scholar
  15. 15.
    Riquelme A, Calvo M, Salech F, et al (2006) Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. J Clin Gastroenterol 40: 705–710PubMedCrossRefGoogle Scholar
  16. 16.
    Banales JL, Pineda PR, Fitzgerald JM, et al (1991) Adenosine deaminase in the diagnosis of tuberculous pleural effusions. A report of 218 patients and review of the literature. Chest 99: 355–357PubMedCrossRefGoogle Scholar
  17. 17.
    Valdes L, Alvarez D, San Jose E, et al (1998) Tuberculous pleurisy: a study of 254 patients. Arch Intern Med 158: 2017–2021PubMedCrossRefGoogle Scholar
  18. 18.
    Villegas MV, Labrada LA, Saravia NG (2000) Evaluation of polymerase chain reaction, adenosine deaminase, and interferon-gamma in pleural fluid for the differential diagnosis of pleural tuberculosis. Chest 118: 1355–1364PubMedCrossRefGoogle Scholar
  19. 19.
    Tuon EF, Higashino HR, Banks MI, et al (2010) Adenosine deaminase and tuberculous meningitis-a systematic review with meta-analysis. Scand J Infect Disease 42: 198–207CrossRefGoogle Scholar
  20. 20.
    Jiang J, Shi HZ, Liang QL, Qin SM, Qin XJ (2007) Diagnostic value of interferon-gamma in tuberculous pleurisy: a metaanalysis. Chest 131: 1133–1141PubMedCrossRefGoogle Scholar
  21. 21.
    Shah S, Miller A, Mastellone A, et al (1998) Rapid diagnosis of tuberculosis in various biopsy and body fluid specimens by the AMPLICOR Mycobacterium tuberculosis polymerase chain reaction test. Chest 113: 1190–1194PubMedCrossRefGoogle Scholar
  22. 22.
    Pfyffer GE, Kissling P, Jahn EM, Welscher HM, Salfinger M, Weber R (1996) Diagnostic performance of amplified Mycobacterium tuberculosis direct test with cerebrospinal fluid, other non respiratory, and respiratory specimens. J Clin Microbiol 34: 834–841PubMedGoogle Scholar
  23. 23.
    Arias M, Mello FC, Pavon A, et al (2007) Clinical evaluation of the microscopic-observation drug-susceptibility assay for detection of tuberculosis. Clin Infect Dis 44: 674–680PubMedCrossRefGoogle Scholar
  24. 24.
    Boehme CC, Nabeta P, Hillemann D, et al (2010) Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med 363: 1005–1015PubMedCrossRefGoogle Scholar
  25. 25.
    Varma-Basil M, El-Hajj H, Colangeli R, et al (2004) Rapid detection of rifampin resistance in Mycobacterium tuberculosis isolates from India and Mexico by a molecular beacon assay. J Clin Microbiol 42: 5512–5516PubMedCrossRefGoogle Scholar
  26. 26.
    Blumberg HM, Burman WJ, Chaisson RE, et al (2003) American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 167: 603PubMedCrossRefGoogle Scholar
  27. 27.
    Ho CC, Chen YC, Hu FC, Yu CJ, Yang PC, Luh KT (2009) Safety of fluoroquinolone use in patients with hepatotoxicity induced by anti-tuberculosis regimens. Clin Infect Dis 48: 1526–1533PubMedCrossRefGoogle Scholar
  28. 28.
    Dorman SE, Johnson JL, Goldberg S, et al (2009) Substitution of moxifloxacin for isonia-zid during intensive phase treatment of pulmonary tuberculosis. Am J Respir Crit Care Med 180: 273–280PubMedCrossRefGoogle Scholar
  29. 29.
    Mitchison DA, Nunn AJ (1986) Influence of initial drug resistance on the response to short-course chemotherapy of pulmonary tuberculosis. Am Rev Respir Dis 133: 423–430PubMedGoogle Scholar
  30. 30.
    Hong Kong Chest Service, British Medical Research Council (1987) Five-year follow-up of a controlled trial of five, 6 month regimens of chemotherapy for tuberculosis. Am Rev Respir Dis 136: 1339–1342Google Scholar
  31. 31.
    Keshayjee S, Gelmanova IY, Farmer PE, et al (2008) Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study. Lancet 372: 1363CrossRefGoogle Scholar
  32. 32.
    Mitnick CD, Shin SS, Seung KJ, et al (2008) Comprehensive treatment of extensively drug-resistant tuberculosis. N Engl J Med 359: 563–574PubMedCrossRefGoogle Scholar
  33. 33.
    Diacon AH, Pym A, Grobusch M, et al (2009) The diarylquinoline TMC207 for multidrug-resistant tuberculosis. N Engl J Med 360: 2397–2405PubMedCrossRefGoogle Scholar
  34. 34.
    Matsumoto M, Hashizume H, Tomishige T, et al (2006) OPC-67683, a Nitro-dihydro-imidazooxazole derivative with promising action against tuberculosis in vitro and in mice. PLoS Med 3: e466PubMedCrossRefGoogle Scholar
  35. 35.
    Diacon AH, Dawson R, Hanekom M, et al (2010) Early bactericidal activity and pharmacokinetics of PA-824 in smear-positive tuberculosis patients. Antimicrob Agents Chemother 54: 3402–3407PubMedCrossRefGoogle Scholar
  36. 36.
    Rubin ZA, Leonard MK, Martin GS (2006) Brief report: tuberculosis sepsis and activated protein C. Am J Med Sci 332: 48–50PubMedCrossRefGoogle Scholar
  37. 37.
    Suarez-Mendez R, Garcia-Garcia I, Fernandez-Olivera N, et al (2004) Adjuvant interferon gamma in patients with drug — resistant pulmonary tuberculosis: a pilot study. BMC Infect Dis 4: 44PubMedCrossRefGoogle Scholar
  38. 38.
    Sung SW, Kang CH, Kim YT, Han SK, Shim YS, Kim JH (1999) Surgery increased the chance of cure in multi-drug resistant pulmonary tuberculosis. Eur J Cardiothorac Surg 16: 187–193PubMedCrossRefGoogle Scholar
  39. 39.
    Somocurcio JG, Sotomayor A, Shin S, et al (2007) Surgery for patients with drug-resistant tuberculosis: report of 121 cases receiving community-based treatment in Lima, Peru. Thorax 62: 416–421PubMedCrossRefGoogle Scholar
  40. 40.
    Wejse C, Gomes VF, Rabna P, et al (2009) Vitamin D as supplementary treatment for tuberculosis: a double-blind, randomized, placebo-controlled trial. Am J Respir Crit Care Med 179: 843–850PubMedCrossRefGoogle Scholar
  41. 41.
    Karyadi E, West CE, Schultink W, et al (2002) A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status. Am J Clin Nutr 75: 720–727PubMedGoogle Scholar
  42. 42.
    Range N, Andersen AB, Magnussen P, et al (2005) The effect of micronutrient supplementation on treatment outcome in patients with pulmonary tuberculosis: a randomized controlled trial in Mwanza, Tanzania. Trop Med Int Health 10: 826–832PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2011

Authors and Affiliations

  • S. Jog
    • 1
  • B. Pawar
    • 1
  • D. Patel
    • 1
  1. 1.Department of Intensive CareDeenathan Mangeshkar HospitalPuneIndia

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