Diagnosis and management of severe pulmonary and extrapulmonary tuberculosis in critically ill patients: A mini review for clinicians

Table 1 Other causes for intensive care unit admissions[5]

Presentation	Potential cause
Massive haemoptysis	Rasmussen aneurysm
Cardiogenic shock	Massive pericardial effusion from TB pericarditis
Liver failure	Drug reaction
Renal failure	Drug reaction (usually rifampicin)
Disseminated intravascular coagulation	Miliary TB
Pituitary apoplexy/stroke mimics	Cerebral tuberculoma
Airway obstruction	Laryngeal/retropharyngeal TB
Known TB patient electively admitted	Post-thoracic surgery

TB: Tuberculosis.

Table 2 Methods of collection and processing sputum samples for diagnosis of tuberculosis[42]

Specimen	Amount	Preservation	Comment
Sputum	2-5 mL	Unprocessed	At least 2x, recommended to be in the morning on an empty stomach
Induced sputum	2-5 mL	Unprocessed	Expectoration following inhalation of 3% NaCl solution
Bronchial secretions or bronchoalveolar lavage samples	2-5 mL	Unprocessed	BAL-ELISPOT should be performed on the same day of sample collection
Gastric aspirates	> 2 mL	In 1-2 mL phosphate buffer (trinatrium phosphate)	Early morning gastric aspirates, only when sputum cannot be aspirated and when bronchoscopy and lavage is not indicated

BAL-ELISPOT: Bronchoalveolar lavage enzyme-linked immunosorbent spot assay used in detection of tuberculosis.

Table 3 Methods of collection and processing of non-sputum samples for diagnosis of tuberculosis[42]

Specimen	Amount	Preservation	Comment
Biopsy of specimen (e.g., lymph nodes, peritoneal biopsies)	2 separate portions	In 0.9% NaCl for microbiological examination	N/A
		In formalin for histopathological examination
Pleural effusion/ascites	At least 20 mL	Unprocessed	ELISPOT should be performed on the same day of sample collection
CSF	2-3 mL	Unprocessed	ELISPOT should be performed on the same day of sample collection
Urine	30 mL	Unprocessed	3x specimen. First specimen of urine in the morning with fluid restriction the evening/night before
Stool	5-10 mL	Unprocessed	3x specimen
Blood	5-10 mL	Heparin- or lithium-citrated tubes	Only in immunosuppressed patients
			Not in EDTA blood
Bone marrow	2 separate portions	In heparin- or lithium-citrated tubes	Only in immunosuppressed patients
		Air-dried smears and/or formalin preserved biopsies
			Not in EDTA blood

EDTA: Ethylenediaminetetraacetic acid, used in the prevention of blood clotting through calcium chelation; ELISPOT: Enzyme-linked immunosorbent spot assay used in detection for tuberculosis; N/A: Not applicable.

Table 4 Dose adjustment in antituberculosis therapies in patients with renal dysfunction

Antimycobacterial agent	Normal daily dose in adults	CrCl 30-60	CrCl 10-29	CrCl < 10	Haemodialysis	Peritoneal dialysis
Isoniazid	5 mg/kg (typically 300 mg)	No dose adjustment	No dose adjustment	No dose adjustment	No dose adjustment	No dose adjustment
Rifampicin	10 mg/kg (typically 600 mg)	No dose adjustment	No dose adjustment	No dose adjustment	No dose adjustment	No dose adjustment
Ethambutol	15 mg/kg	15 mg/kg/d	15 mg/kg q48h	15 mg/kg q48h	15 mg/kg three times weekly post-HD	15 mg/kg q48h
Pyrazinamide	15-30mg/kg	No dose adjustment	15-30 mg/kg q48h	15-30 mg/kg three times weekly	15-30 mg/kg three times weekly post-HD	No dose adjustment

HD: Haemodialysis.