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Clinical presentation and outcome of patients diagnosed with active pulmonary tuberculosis in a large critical care unit
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Clinical presentation and outcome of patients diagnosed with active pulmonary tuberculosis in a large critical care unit
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New cases of active pulmonary tuberculosis admitted to our critical care unit from January 1999 to January 2006 were identified. Data were collected retrospectively from medical records including demographics, clinical presentation, number of sputum samples, therapy provided and patient outcome. Setting: Data were collected from the ICU database and microbiology laboratory records. Patients and participants: Thirty-three patients were diagnosed with active pulmonary tuberculosis. Age was 63±17, and 60.7% were males. Onset of symptoms averaged 17 days prior to presentation (range: 1-90 days), including fever in 51%, cough in 14%, dyspnea in 8%, night sweats in 6% | Original Article Crit Care Shock 2011 14 1-6 Clinical presentation and outcome of patients diagnosed with active pulmonary tuberculosis in a large critical care unit Abdullah A. Alshimemeri Yaseen M. Arabi Hamdan Al-Jahdali Ashwaq Olayan Othman Al Harbi Ziad Memish Abstract Objective To examine the presentation and outcome of patients diagnosed with active pulmonary tuberculosis after admission to the intensive care unit ICU . Design New cases of active pulmonary tuberculosis admitted to our critical care unit from January 1999 to January 2006 were identified. Data were collected retrospectively from medical records including demographics clinical presentation number of sputum samples therapy provided and patient outcome. Setting Data were collected from the ICU database and microbiology laboratory records. Patients and participants Thirty-three patients were diagnosed with active pulmonary tuberculosis. Age was 63 17 and 60.7 were males. Onset of symptoms averaged 17 days prior to presentation range 1-90 days including fever in 51 cough in 14 dyspnea in 8 night sweats in 6 . Interventions Twenty-two patients were treated for tuberculosis during hospitalization. The other 11 were Key words Tuberculosis ICU retrospective misdiagnosis. not diagnosed during hospitalization and were found later to be culture positive. Measurements and results The most common ICU clinical diagnosis was community-acquired pneumonia in 54 followed by aspiration pneumonia in 3 . Out of 161 tracheal aspirates only 48 30 were AFB stain positive and 80 69 were culture positive. Out of 33 patients who had at least one positive culture only 62 were AFB stain positive. Of the 22 patients treated for tuberculosis during hospitalization 15 68 died. Of the remaining 11 who were not diagnosed during hospitalization 7 64 died. Conclusions Active pulmonary tuberculosis is common in ICU patients. The diagnosis may be confounded by atypical clinical presentation and the lack of sensitive and rapid .
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