Introduction :

Tuberculosis  (TB) is a common infectious disease with severe forms. Interest in inflammatory mechanisms and the prospect of benefiting corticosteroid as an adjunct to antibacterial therapy in severe forms, has revived.

Methods:

Comparative retrospective study, conducted from 2009 to 2022, including 105 patients with severe tuberculosis followed at pulmonology C department in Mami Ariana?s Hospital.

2 groups were defined according to the use of corticosteroid therapy.

Results:

The mean age of our patients was 42 ± 16 years.

Corticosteroid therapy was used in 34 patients (32.4 %): miliary TB 10 patients (29%), respiratory insufficiency 15 patients  (44%), Central nervous system (CNS) involving 7 (20.6%)  and pericarditis 3 (8.8%).The most severe TB forms, associated with the use of corticosteroids, were Central nervous system TB  (20.6% vs. 5.6 %; p=0.26) and miliary TB (29.4% vs. 8.5%; p=0.007).

Patients with severe  TB forms receiving corticosteroid therapy had more complications such as pneumothorax, hemoptysis or  acute respiratory failure (55.7% vs. 21.1%.; p=0.026).

The 90-day mortality rate was 14.3 % (15/105).

Other than for tuberculous meningitis and effusive pericarditis, The 90-day mortality rate was significantly higher in patients  receiving corticosteroid therapy  (35.3% vs. 9.9 %; p=0.002)

A lower mortality rate was noted in patients with pericarditis, but the incidence of subsequent constriction was not changed.

Conclusion

Adjunctive corticosteroid therapy appears to offer significant short-term but (other than for tuberculous meningitis and effusive pericarditis) minimal long-term benefit for patients with tuberculosis.