High Prevalence of Tuberculosis and Serious Bloodstream Infections in Ambulatory Individuals Presenting for Antiretroviral Therapy in Malawi

Hdl Handle:
http://hdl.handle.net/10144/241788
Title:
High Prevalence of Tuberculosis and Serious Bloodstream Infections in Ambulatory Individuals Presenting for Antiretroviral Therapy in Malawi
Authors:
Bedell, R A; Anderson, S T B; van Lettow, M; Åkesson, A; Corbett, E L; Kumwenda, M; Chan, A K; Heyderman, R S; Zachariah, R; Harries, A D; Ramsay, A R; Polis, M A
Journal:
PLoS One
Abstract:
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 (<2 for all combinations). Conclusions We observed a high prevalence of TB and serious BSI, particularly NTS, in a program cohort of chronically ill HIV-infected outpatients. Baseline clinical and hematological characteristics were inadequate predictors of infection. HIV clinics need better rapid screening tools for TB and BSI. Clinical trials to evaluate empiric TB or NTS treatment are required in similar populations.
Affiliation:
Dignitas International, Zomba, Malawi; Division of Global Health, University of British Columbia, Vancouver, British Columbia, Canada; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Department of Medicine, Brighton and Sussex Medical School, Falmer, Sussex, United Kingdom; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Médecins Sans Frontières – Operational Centre Brussels, Thyolo, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Médecins Sans Frontières – Operational Centre Brussels, Brussels, Belgium; International Union Against Tuberculosis and Lung Disease, Paris, France; World Health Organization, Geneva, Switzerland; School of Medicine, University of St. Andrews, Fife, Scotland
Publisher:
Public Library of Science (PLoS)
Issue Date:
22-Jun-2011
URI:
http://hdl.handle.net/10144/241788
DOI:
10.1371/journal.pone.0039347
Additional Links:
http://dx.plos.org/10.1371/journal.pone.0039347
Submitted date:
2011-12-06
Type:
Article
Language:
en
ISSN:
1932-6203
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorBedell, R Aen_GB
dc.contributor.authorAnderson, S T Ben_GB
dc.contributor.authorvan Lettow, Men_GB
dc.contributor.authorÅkesson, Aen_GB
dc.contributor.authorCorbett, E Len_GB
dc.contributor.authorKumwenda, Men_GB
dc.contributor.authorChan, A Ken_GB
dc.contributor.authorHeyderman, R Sen_GB
dc.contributor.authorZachariah, Ren_GB
dc.contributor.authorHarries, A Den_GB
dc.contributor.authorRamsay, A Ren_GB
dc.contributor.authorPolis, M Aen_GB
dc.date.accessioned2012-09-07T12:32:03Z-
dc.date.available2012-09-07T12:32:03Z-
dc.date.issued2011-06-22-
dc.date.submitted2011-12-06-
dc.identifier.citationPLoS ONE 7(6): e39347. doi:10.1371/journal.pone.0039347en_GB
dc.identifier.issn1932-6203-
dc.identifier.doi10.1371/journal.pone.0039347-
dc.identifier.urihttp://hdl.handle.net/10144/241788-
dc.description.abstractBackground 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 (<2 for all combinations). Conclusions We observed a high prevalence of TB and serious BSI, particularly NTS, in a program cohort of chronically ill HIV-infected outpatients. Baseline clinical and hematological characteristics were inadequate predictors of infection. HIV clinics need better rapid screening tools for TB and BSI. Clinical trials to evaluate empiric TB or NTS treatment are required in similar populations.en_GB
dc.language.isoenen
dc.publisherPublic Library of Science (PLoS)en_GB
dc.relation.urlhttp://dx.plos.org/10.1371/journal.pone.0039347en_GB
dc.rightsPublished by Public Library of Science, [url]http://www.plosone.org/[/url] Archived on this site by Open Access permissionen_GB
dc.subjectTuberculosisen_GB
dc.subjectInfectionen_GB
dc.subjectARTen_GB
dc.titleHigh Prevalence of Tuberculosis and Serious Bloodstream Infections in Ambulatory Individuals Presenting for Antiretroviral Therapy in Malawien
dc.typeArticleen
dc.contributor.departmentDignitas International, Zomba, Malawi; Division of Global Health, University of British Columbia, Vancouver, British Columbia, Canada; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Department of Medicine, Brighton and Sussex Medical School, Falmer, Sussex, United Kingdom; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Médecins Sans Frontières – Operational Centre Brussels, Thyolo, Malawi; London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Médecins Sans Frontières – Operational Centre Brussels, Brussels, Belgium; International Union Against Tuberculosis and Lung Disease, Paris, France; World Health Organization, Geneva, Switzerland; School of Medicine, University of St. Andrews, Fife, Scotlanden_GB
dc.identifier.journalPLoS Oneen_GB
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