Delayed Death From Pulmonary Tuberculosis
Delayed Death From Pulmonary Tuberculosis
A patient with fulminant pulmonary tuberculosis died after 41 days of intensive care despite pansensitive organisms and no known underlying immunosuppression. Two factors leading to death in this patient were a delay in seeking medical attention and a subtherapeutic serum level of rifampin, though no obvious evidence of malabsorption existed. Malabsorption of antitubercular drugs is under-recognized and of extreme importance in the treatment of critically ill patients with active pulmonary tuberculosis. Factors associated with mortality from tuberculosis and selected aspects of critical care management are discussed.
Death from active pulmonary tuberculosis is a recognized, if uncommon event in the United States, usually occurring due to delayed disease detection and often in the setting of drug resistance, human immunodeficiency virus (HIV) infection, and other comorbidities. In contrast, however, clinicians expect patients without these factors to survive. This report describes the case of a patient with appropriately treated pulmonary tuberculosis who died after 41 days of intensive care unit (ICU) treatment despite pansensitive organisms. In addition, a subtherapeutic serum rifampin level was discovered and may have contributed to her death. Because few resources exist describing treatment of critically ill patients with active tuberculosis, practical considerations for their treatment are discussed.
A patient with fulminant pulmonary tuberculosis died after 41 days of intensive care despite pansensitive organisms and no known underlying immunosuppression. Two factors leading to death in this patient were a delay in seeking medical attention and a subtherapeutic serum level of rifampin, though no obvious evidence of malabsorption existed. Malabsorption of antitubercular drugs is under-recognized and of extreme importance in the treatment of critically ill patients with active pulmonary tuberculosis. Factors associated with mortality from tuberculosis and selected aspects of critical care management are discussed.
Death from active pulmonary tuberculosis is a recognized, if uncommon event in the United States, usually occurring due to delayed disease detection and often in the setting of drug resistance, human immunodeficiency virus (HIV) infection, and other comorbidities. In contrast, however, clinicians expect patients without these factors to survive. This report describes the case of a patient with appropriately treated pulmonary tuberculosis who died after 41 days of intensive care unit (ICU) treatment despite pansensitive organisms. In addition, a subtherapeutic serum rifampin level was discovered and may have contributed to her death. Because few resources exist describing treatment of critically ill patients with active tuberculosis, practical considerations for their treatment are discussed.
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