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Management of children with tuberculosis admitted to a pediatric intensive care unit
1Department of Paediatrics and Child Health, Tygerberg Hospital and the University of Stellenbosch, Western Cape Province, South Africa.
Insights
Tuberculosis (TB) in children admitted to the Pediatric Intensive Care Unit (PICU) is common in high-incidence areas. TB meningitis poses the highest mortality risk, highlighting the need for early diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Tuberculosis (TB) remains a significant global health challenge, particularly in high-incidence regions.
- Pediatric Intensive Care Units (PICUs) manage critically ill children, including those with severe infectious diseases.
Purpose of the Study:
- To determine the incidence, clinical characteristics, ventilatory support, and outcomes of children with TB admitted to a PICU.
- To assess the impact of TB on PICU admissions in a high-incidence area.
Main Methods:
- Retrospective descriptive study of TB admissions to a PICU over a 4-year period.
- Data collected included admission indications, clinical presentation, ventilation requirements, and PICU/hospital stay duration.
- Outcomes assessed were mortality and long-term morbidity.
Main Results:
- 57 (3.1%) of 1862 TB hospital admissions required PICU care.
- Respiratory failure was the primary reason for PICU admission in 72% of cases.
- PICU mortality was 23%, with TB meningitis having a 75% mortality rate.
Conclusions:
- Children with TB constitute a notable proportion (up to 6%) of PICU admissions in high-incidence areas.
- A high index of suspicion is crucial, as TB was not initially diagnosed in 30% of cases.
- TB meningitis is associated with particularly poor outcomes in the PICU.
Objectives:
To review the incidence, clinical features, ventilatory support and outcome of children with tuberculosis (TB) admitted to a Pediatric Intensive Care Unit (PICU) in a region with an high incidence of TB.
Materials And Methods:
The study was performed in a PICU situated in a province with a extremely high incidence of TB (> 700 new cases/ 100000/year). This is a retrospective descriptive study of TB admissions to the PICU in a 4-year period. Data regarding indications for admission, clinical picture, duration of ventilation, PICU and hospital stay were collected from patient files. Outcome measures included mortality and long term morbidity.
Results:
Of the 1862 children admitted to the hospital for TB during the 4 years, 57 (3.1%) required PICU admission (1 to 6% of annual admissions). Of these 57 children 41 (72%) were admitted for respiratory failure. In 12 cases TB was the cause of the respiratory failure, 17 cases suffered from other respiratory diseases and in 12 cases the cause was nonrespiratory disease of which TB meningitis (n=8) was the most common. Mechanical ventilation was indicated in 43 (75%) patients who were ventilated for 7.3+/-11.5 days. The duration of PICU admission was 10.2+/-2.4 days whereas the duration of hospitalization was 70.3+/-148.9 days. The PICU mortality was 23% with TB meningitis having the highest mortality of 75%.
Conclusions:
In a region with a high incidence of TB, tuberculous patients constitute up to 6% of PICU admissions. A high degree of suspicion for the diagnosis is needed because in 30% of our cases the diagnosis was not initially considered.