PROGNOSIS OF ADULT-RESPIRATORY-DISTRESS-S YNDROME IN TUBERCULOSIS PATIENTS - 4 CASES REPORTS

Objectives: We examined the characteristics of 4 cases of adult respir atory distress syndrome in patients with tuberculosis in an attempt to improve prognosis. Methods: Four new cases of adult respiratory distr ess syndrome were described together with a review of the cases report ed in the literature. Inclusion criteria were the presence of the synd rome as defined according to the Americain-European consensus conferen ce and the criteria described by Murray et al. and identification of t he mycobacteria causing tuberculosis. Results: A total of 52 cases wer e included in the study. The sex ratio was 0.71 and mean age 46 +/- 15 years. Eight patients had a past history of pulmonary tuberculosis. A lcoholism was the primary immunodepression factor observed (35%) follo wed by human immunodeficiency virus infection (13%). For 74% of the pa tients, the disease course lasted 7 days. The initial chest X-ray was suggestive of tuberculosis in 11. Intradermoreaction to tuberculin was positive in 2 out of 17 patients. Direct examination of non-invasive respiratory samples was positive in 44% for mycobacteria. Disseminated tuberculosis was seen in 64%. Anti-tuberculosis antibiotherapy was st arted on the first day of intensive care in 68% of the patients; rapid treatment was associated with better prognosis: 1.5 +/- 1.2 days vers us 3 +/- 2.7 in fatal cases (p = 0.02). Adjuvant corticosteroid therap y was used in 46% of the cases and was apparently associated with unfa vourable outcome: 74% mortality versus 58% without corticosteroids. Ve ntilatory assistance was required in 88% and associated with poor prog nosis (13% survival versus 100% without assistance) (p <10(3)). Outcom e was fatal in 36 cases (70%) with a mean delay of 9.7 +/- 10.8 days. Conclusion: The conditions required for improving the prognosis of adu lt respiratory distress syndrome in tuberculosis patients included sus pecting tuberculosis in all cases of acute respiratory failure of unkn own origin, particularly in the immunodepressed patient, and to avoid missing this diagnosis in case of a non-suggestive chest X-ray and a n egative though exhaustive microbiology search. Adjuvant corticotherapy is uneffective and mag be dangerous.