Mycobacterium tuberculosis inducing disseminated intravascular coagulation

Abstract

Disseminated intravascular coagulation (DIC) can develop infrequently in patients with tuberculosis and has a very high mortality rate. We conducted a retrospective study to evaluate the incidence of tuberculosis-induced DIC and to investigate the clinical manifestation, outcome, and prognostic factors of such patients. From January 2002 to December 2003, all culture-proven tuberculosis patients who developed DIC before starting anti-tuberculosis treatments were selected for this study. Patients who had other clinical conditions or were infected by other pathogens that may have been responsible for their DIC were excluded. Survival analysis was performed for each variable with possible prognostic significance. Our results showed that 27 (3.2%) out of the 833 patients with culture-proven tuberculosis had tuberculosis-induced DIC with a mortality rate of 63.0%. The most common clinical manifestations were fever (63.0%) and multiple patches of pulmonary consolidation (59.3%). Seven (25.9%) patients had disseminated tuberculosis. Twelve (44.4%) developed acute respiratory distress syndrome and three (11.1%) were associated with hemophagocytosis. Twenty-four (88.9%) patients had findings that were unusual for an acute bacterial infection, such as positive acid-fast smear, miliary pulmonary lesions, lymphocytotic exudative pleural effusion, and mediastinal lymphadenopathy. Early anti-tuberculosis treatment significantly improved survival. In conclusion, tuberculosis can cause DIC. Patients with non-miliary, non-disseminated tuberculosis could also develop the rare clinical manifestation. Since the prognosis was very poor in patients not treated at an early stage, a high index of suspicion is required, especially in those with clinical findings suggestive of tuberculosis.

Causes, clinical symptoms, and outcomes of infectious diseases associated with hemophagocytic lymphohistiocytosis in Taiwanese adults

“…Three of these seven patients were diagnosed with disseminated intravascular coagulation because of M tuberculosis infection at the initial presentation. 20 Five out of the seven patients (71%) with M tuberculosis-related HLH died. Only three of the five patients received antituberculosis therapy before their death.…”

Performance Assessment of the DR. MTBC Screen Assay and the BD ProbeTec ET System for Direct Detection of Mycobacterium tuberculosis in Respiratory Specimens

“…Therefore, delay in diagnosis and treatment can risk the dissemination of M. tuberculosis to others. In addition, recent studies found that early treatment improved survival in patients with tuberculosis (1,14,20). For these reasons, it is particularly important to diagnose tuberculosis as early as possible.…”

Miliary Tuberculosis in a Healthy Adult

“…Development of DIC is fortunately rare in patients with active tuberculosis but is found in 4.4% of patients with miliary TB. 11,12 The treatment of DIC in general and specifically in patients with miliary TB has a poor response and is largely ineffective.…”