The outcome of infants younger than 6 months requiring ventilation for pneumonia caused by Mycobacterium tuberculosis

Introduction The outcome of young infants (<6 months) being ventilated for respiratory failure caused by Mycobacterium tuberculosis (MTB) has not been recorded. Patients and Methods A descriptive study of children <6 months admitted to the PICU from 1 February 1999 to 31 December 2005 with MTB causing respiratory failure. Results Seventeen infants were ventilated for respiratory failure caused by MTB: ten had ventilatory respiratory failure and seven had hypoxic failure. An index case was found in 47%. All chest radiographs (CXRs) were highly suggestive of tuberculosis. MTB was cultured in 15 cases. In the other two cases MTB was confirmed by histopathology. The median duration of ventilation was 6 days (range: 1–35 days) with a median PaO2/FiO2 of 85 and ventilatory index of 58. Transthoracic glandular enucleation was required to facilitate extubation in six babies. All the infants survived. At 6-month follow-up 35% had a normal CXR and all were asymptomatic. One child had CXR changes suggestive of bronchiectasis but was asymptomatic. Conclusion The outcome of infants <6 months ventilated for respiratory failure caused by MTB is very good if TB is recognized timeously and appropriate management started. The diagnosis of TB in these infants can be made with a high index of suspicion and careful evaluation of the CXR. Pediatr Pulmonol. 2008; 43:505–510. © 2008 Wiley-Liss, Inc.