Tuberculosis is always a possibility (even in the intensive care unit) - Critical Care Science (CCS)

Tuberculosis is always a possibility (even in the intensive care unit) |

INTRODUCTION

Community-acquired pneumonia (CAP) requiring hospitalization is mainly caused by Streptococcus pneumoniae and respiratory viruses.⁽⁾ Among patients with severe CAP, including those requiring admission to an intensive care unit, additional important pathogens include Staphylococcus aureus, Gram-negative bacteria, and Legionella pneumophila.^(,)

Typically, Mycobacterium tuberculosis is not a pathogen that is strongly considered in patients with CAP because it is usually associated with a more protracted illness course and characteristic cavitary lesions on chest imaging. However, evidence exists that M. tuberculosis infection can, in fact, present with clinical manifestations consistent with CAP. For instance, using the Community-Acquired Pneumonia Organization database, which is a multinational cohort of adults hospitalized with CAP, our group found that of the 6,976 patients in the database, 60 (0.86%) had infection caused by M. tuberculosis.⁽⁾ In a study from Malaysia that included 346 patients older than 12 years of age who were hospitalized with CAP, M. tuberculosis was identified in 17 (4.9%) patients.⁽⁾ In a study that included 103 patients with pneumonia presenting to the emergency room of a hospital in Bronx, NY, USA, 22 (21%) patients had infection caused by M. tuberculosis.⁽⁾ The proportion of patients with tuberculosis (TB) varied considerably among these studies, which may reflect different incidences of TB in the regions where the studies were conducted.

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