Miliary tuberculosis leading to acute respiratory distress syndrome: Clinical experience in pediatric intensive care

Piastra, Marco; Picconi, Enzo; Morena, Tony Christian; Valentini, Piero; Buonsenso, Danilo; Conti, Giorgio; Antonelli, Massimo; Wolfler, Andrea; Chidini, Giovanna; Pons-Òdena, Martí; Pascale, Gennaro De

doi:10.1002/ppul.24510

Cited by 6 publications

(4 citation statements)

References 20 publications

(32 reference statements)

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“…According to our data, the disease is more likely to occur in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy; in other words, the symptom onset in the former group is earlier than that in the latter group. The time from IVF-ET to symptom onset in our study was in line with those reported in other studies [ 22 , 23 ]. Our study shows that the time from symptom onset to diagnosis is relatively long, suggesting that it is difficult to diagnose the disease and that misdiagnosis is common in the early stages.…”

Section: Discussionsupporting

confidence: 93%

Clinical analysis of pregnancy complicated with miliary tuberculosis

et al. 2021

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Background Pregnancy complicated with tuberculosis is increasingly common. The clinical characteristics of pregnancy complicated with miliary tuberculosis are summarized in this study. Methods A retrospective analysis of pregnant patients with miliary tuberculosis was performed in terms of epidemiology, demography, clinical characteristics, laboratory tests, treatment, and prognosis. Results Of the 23 patients that were included, 12 became pregnant after in vitro fertilization combined with embryo transfer (IVF-ET). The average gestational age at symptom onset was 13.96 weeks, and the average time from symptom onset to diagnosis was 33 days. Clinical symptoms included fever, dyspnoea, cough, headache, abdominal pain, and chest pain. Extrapulmonary tuberculosis occurred in 10 patients, respiratory failure in 11 patients, and ARDS in 9 patients. Chest HRCT showed diffusely distributed miliary nodules in all patients. Six patients were on mechanical ventilation, two underwent ECMO, and one died. Symptoms appeared in the first trimester of nine pregnancies after IVF-ET and in the second trimester of seven natural pregnancies. Conclusions Miliary tuberculosis can occur in pregnant patients, especially in patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Lacking specificity, the common clinical characteristics include elevated inflammation markers, anaemia, low lymphocyte count, and multiple miliary nodules shown on a chest HRCT scan. Half of patients with miliary tuberculosis may develop respiratory failure, and some may progress to ARDS. Therefore, infertile patients should be required to undergo TB screening before undergoing IVF-ET, and preventive anti-TB treatment should be given to patients with latent TB infections or untreated TB disease. Key Message Miliary tuberculosis can occur in pregnant patients, especially in pregnant patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Many patients develop respiratory failure or ARDS.

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Section: Discussionsupporting

confidence: 93%

Clinical analysis of pregnancy complicated with miliary tuberculosis

et al. 2021

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“…The diagnosis of miliary TB can be delayed owing to the various clinical manifestations of PARDS, leading to a poor prognosis. Piastra et al ( 5 ) reported 3 cases of miliary TB complicated by PARDS. The patients were critically ill and had severe complications such as pneumothorax and septic shock.…”

Section: Introductionmentioning

confidence: 99%

“…Acute respiratory distress syndrome (ARDS) owing to diffuse alveolar damage is a rare complication of miliary TB (3). To our knowledge, only five children (<15 years) with miliary TB and pediatric ARDS (PARDS) have been reported since 1995 (4)(5)(6)(7). This severe comorbidity causes critically severe illness with a high mortality rate.…”

Section: Introductionmentioning

confidence: 99%

Case report: Miliary tuberculosis complicated by pediatric acute respiratory distress syndrome in a 12-year-old girl

Zhu,

Chen,

Shang

et al. 2023

Front. Pediatr.

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Acute respiratory distress syndrome (ARDS) is a rare complication of miliary tuberculosis, particularly in pediatric patients. Comorbidities and delayed diagnosis can worsen the prognosis of patients with miliary tuberculosis. A 12-year-old girl presented with fever for 20 days, and cough and tachypnea for 4 days. She was diagnosed with miliary tuberculosis complicated by pediatric ARDS. She had atypical clinical manifestations and imaging findings, a negative contact history, and negative results of a tuberculin skin test (TST) and T-SPOT.TB. Diagnostic bronchoscopy and bronchoalveolar lavage helped make the diagnosis of tuberculosis. Effective treatment was promptly initiated after confirmation of the diagnosis, and the patient's condition improved. This case illustrates that a negative contact history and laboratory results cannot rule out tuberculosis. False-negative TST and T-SPOT.TB results should be evaluated carefully. Bronchoscopy may be useful for identifying pathogens in patients with pneumonia of unknown etiology, and corticosteroids should be administered with caution.

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“…Children with miliary tuberculosis very rarely present with acute respiratory failure. [ 1 ] Also, spontaneous pneumothorax (“non-traumatic”) has seldom been reported in children having miliary tuberculosis. [ 2 3 4 ] The probable mechanism of spontaneous pneumothorax in miliary tuberculosis is rupture of confluent sub-pleural miliary nodules secondary to caseation and necrosis, or rupture of a bullous lesion developed near miliary tubercles.…”

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confidence: 99%