Mortality of patients while on treatment for active tuberculosis

In the era of effective antituberculous chemotherapy, some patients with tuberculosis still die while on treatment. The aim of this study was to review deaths occurring in patients while on treatment for active tuberculosis in Alexandra Hospital during the 4-year period from 1991 to 1994. Medical records of 30 such patients were reviewed retrospectively. Twenty-one patients were certified as dying from tuberculosis; in the remaining 9 patients, the principal cause of death was other than tuberculosis. Of the patients who died of tuberculosis, 7 (33.3%) died within a week and 19 (90.5%) died within a month of initiation of antituberculous treatment. Seventeen (81%) were males and 15 (71%) were smokers. All the 21 patients had pulmonary involvement and in 4 patients, there was disseminated disease. Chest roentgenographic findings of bilateral involvement were seen in 16 (76.2%) patients and of cavitary disease in 15 (71.4%) patients. Eighteen (86%) had a positive sputum smear result. Seven patients received corticosteroid cover. In 14 patients who had their weights recorded at initiation of antituberculous treatment, the mean weight was 36.3 kg (range 25.5k g-47k g). Notable biochemical derangements included hyponatraemia (86%) and hypoalbuminaemia (95%). Plasma cortisol and/or Synacthen stimulation test were performed in 4 patients; none was indicative of adrenal hypofunction. We conclude that death attributed to tuberculosis in patients while on treatment occurs early and is largely due to advanced disease.