Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected children and infants in northern Tanzania
| Autor: | Crump, John A., Ramadhani, Habib O., Morrissey, Anne B., Msuya, Levina J., Yang, Lan-Yan, Chow, Shein-Chung, Morpeth, Susan C., Reyburn, Hugh, Njau, Boniface N., Shaw, Andrea V., Diefenthal, Helmut C., Bartlett, John A., Shao, John F., Schimana, Werner, Cunningham, Coleen K., Kinabo, Grace D. |
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| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Male
Inpatients AIDS-Related Opportunistic Infections Adolescent Fever Plasmodium falciparum Infant Salmonella enterica Bacteremia HIV Infections Bacterial Infections Tanzania Article CD4 Lymphocyte Count Malaria Hospitalization Streptococcus pneumoniae Mycoses Child Preschool HIV-1 Humans Female Hospital Mortality Child |
| Popis: | To describe the contribution of paediatric HIV and of HIV co-infections to admissions to a hospital in Moshi, Tanzania, using contemporary laboratory methods.During 1 year, we enrolled consecutively admitted patients aged ≥2 months and13 years with current or recent fever. All patients underwent standardized clinical history taking, a physical examination and HIV antibody testing; standard aerobic blood cultures and malaria film were also done, and hospital outcome was recorded. Early infant HIV diagnosis by HIV-1 RNA PCR was performed on those aged18 months. HIV-infected patients also received serum cryptococcal antigen testing and had their CD4-positive T-lymphocyte count and percent determined.A total of 467 patients were enrolled whose median age was 2 years (range 2 months-13 years); Of those patients, 57.2% were female and 12.2% were HIV-infected. Admission clinical diagnosis of HIV disease was made in 10.7% and of malaria in 60.4%. Of blood cultures, 5.8% grew pathogens; of these 25.9% were Salmonella enterica (including 6 Salmonella Typhi) and 22.2%Streptococcus pneumoniae. Plasmodium falciparum was identified on blood film of 1.3%. HIV infection was associated with S. pneumoniae (odds ratio 25.7, 95% CI 2.8, 234.0) bloodstream infection (BSI), but there was no evidence of an association with Escherichia coli or P. falciparum; Salmonella Typhi BSI occurred only among HIV-uninfected participants. The sensitivity and specificity of an admission clinical diagnosis of malaria were 100% and 40.3%; and for an admission diagnosis of bloodstream infection, they were 9.1% and 86.4%, respectively.Streptococcus pneumoniae is a leading cause of bloodstream infection among paediatric admissions in Tanzania and is closely associated with HIV infection. Malaria was over-diagnosed clinically, whereas invasive bacterial disease was underestimated. HIV and HIV co-infections contribute to a substantial proportion of paediatric febrile admissions, underscoring the value of routine HIV testing. |
| Databáze: | OpenAIRE |
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