Tuberculosis and the intensivist

摘要

In the UK TB is back with 6000 new cases of tuberculosis each year. Intensive care is required in 1-3% of all cases of TB and is associated with very high mortality rates. The most common site of Mycobacterium tuberculosis (MTB) infection is the lungs. Primary infection may present with fever and chest pain with hilar adenopathy, pleural effusions and pulmonary infiltrate. Most commonly the initial infection is asymptomatic but there is a 10% lifetime risk of these foci reactivating to cause disease (higher in immunosuppressed patients). Reactivation TB represents 90% of adult cases in the non-HIV-infected population. Insidious onset of cough, weight loss, fever and night sweats are the most common presentations. Radiologically, infiltrates in the apical-posterior segments of the upper lobes are seen in 80-90% of patients, but other segments of upper or lower lobes may be involved. TB in health care workers is a problem and a recent study found about a twofold increased risk of tuberculosis among health care workers.Recognition of TB infection requires a high index of suspicion, especially in ICU where atypical presentation of the disease is seen more commonly. It is however vital that cases are recognised, both to optimise management of infected patients, and to protect staff and other patients from infection, particularly in an era of increasing antimicrobial resistance. ?2007 Elsevier Ltd. All rights reserved.