High prevalence of tuberculosis and serious bloodstream infections in ambulatory individuals presenting for antiretroviral therapy in Malawi

Autor: Anthony D. Harries, Rony Zachariah, Elizabeth L. Corbett, Adrienne K. Chan, Moses Kumwenda, Andrew Ramsay, Monique van Lettow, Ann Åkesson, Robert S. Heyderman, Richard Bedell, Suzanne T. Anderson
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Male
Bacterial Diseases
Malawi
HIV opportunistic infections
lcsh:Medicine
HIV Infections
Bacteremia
Comorbidity
0302 clinical medicine
Salmonella
Antiretroviral Therapy
Highly Active
Prevalence
Blood culture
Prospective Studies
030212 general & internal medicine
lcsh:Science
Prospective cohort study
Multidisciplinary
medicine.diagnostic_test
Fungal Diseases
Cryptococcosis
Middle Aged
3. Good health
Diarrhea
Salmonella Infections
Cohort
Medicine
Infectious diseases
Female
HIV clinical manifestations
medicine.symptom
Infection
ART
Research Article
Cohort study
Adult
medicine.medical_specialty
Tuberculosis
Anemia
030231 tropical medicine
Viral diseases
03 medical and health sciences
Internal medicine
medicine
Humans
AIDS-Related Opportunistic Infections
business.industry
lcsh:R
Sputum
Tropical Diseases (Non-Neglected)
HIV
Bloodstream Infections
medicine.disease
Immunology
lcsh:Q
business
Zdroj: PLoS ONE, Vol 7, Iss 6, p e39347 (2012)
PLoS ONE
ISSN: 1932-6203
Popis: BACKGROUND: Tuberculosis (TB) and serious bloodstream infections (BSI) may contribute to the high early mortality observed among patients qualifying for antiretroviral therapy (ART) with unexplained weight loss, chronic fever or chronic diarrhea. METHODS AND FINDINGS: A prospective cohort study determined the prevalence of undiagnosed TB or BSI among ambulatory HIV-infected adults with unexplained weight loss and/or chronic fever, or diarrhea in two routine program settings in Malawi. Subjects with positive expectorated sputum smears for AFB were excluded. Investigations Bacterial and mycobacterial blood cultures, cryptococcal antigen test (CrAg), induced sputum (IS) for TB microscopy and solid culture, full blood count and CD4 lymphocyte count. Among 469 subjects, 52 (11%) had microbiological evidence of TB; 50 (11%) had a positive (non-TB) blood culture and/or positive CrAg. Sixty-five additional TB cases were diagnosed on clinical and radiological grounds. Nontyphoidal Salmonellae (NTS) were the most common blood culture pathogens (29 cases; 6% of participants and 52% of bloodstream isolates). Multivariate analysis of baseline clinical and hematological characteristics found significant independent associations between oral candidiasis or lymphadenopathy and TB, marked CD4 lymphopenia and NTS infection, and severe anemia and either infection, but low positive likelihood ratios (
Databáze: OpenAIRE
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