Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon.
Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam Public Health, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, The Netherlands.
Infection. 2023 Jun;51(3):609-621. doi: 10.1007/s15010-022-01950-4. Epub 2022 Nov 16.
Tuberculosis sepsis (TBS) is sepsis due to the Mycobacterium species causing tuberculosis (TB). It seems to be rare in HIV-negative patients and mainly individual case reports have been reported. This systematic review summarizes the epidemiology, clinical features, and treatment outcomes of TBS in HIV-negative patients.
An electronic search of PubMed, Embase, Web of Science, and Google Scholar was performed to identify published case reports of TBS between January 1991 and September 2022.
Twenty-five articles reported 28 cases of TBS in HIV-negative patients, among which 54% (15/28) were women; with 50% (14/28) of patients not having reported predisposing factors. A total of 64% (18/28) of patients died, and the diagnosis was obtained for many of them only post-mortem. Two of the reports mentioned the BCG vaccination status. A higher proportion of deaths occurred in patients with delayed diagnosis of sepsis. The probability of survival of patients diagnosed with tuberculosis sepsis was 68% on day 10; 41% on day 20; and 33% on day 30 after admission.
Our review showed TBS occurred in HIV-negative patients and some of them have no known immunocompromised underlying co-morbidity. TBS might not be rare as clinicians thought but might be prone to be missed. In endemic settings, M. tuberculosis etiology of sepsis should be accounted for early, irrespective of HIV infection status.
结核病败血症（TBS）是由引起结核病（TB）的分枝杆菌属引起的败血症。它似乎在 HIV 阴性患者中很少见，主要是个案报告。本系统评价总结了 HIV 阴性患者中 TBS 的流行病学、临床特征和治疗结果。
对 PubMed、Embase、Web of Science 和 Google Scholar 进行电子检索，以确定 1991 年 1 月至 2022 年 9 月期间发表的 TBS 病例报告。
25 篇文章报道了 28 例 HIV 阴性患者的 TBS，其中 54%（15/28）为女性；50%（14/28）的患者未报告潜在诱发因素。共有 64%（18/28）的患者死亡，其中许多患者仅在死后才确诊。有两份报告提到了卡介苗接种情况。延迟诊断败血症的患者死亡比例更高。确诊为结核病败血症的患者在第 10 天的存活率为 68%；第 20 天为 41%；第 30 天为 33%。
我们的综述表明，TBS 发生在 HIV 阴性患者中，其中一些患者没有已知的免疫功能低下的合并症。TBS 可能不像临床医生认为的那样罕见，但可能容易被忽视。在流行地区，无论 HIV 感染状态如何，都应早期考虑由 M. tuberculosis 引起的败血症。
