High Prevalence of Tuberculosis and Serious Bloodstream Infections in Ambulatory Individuals Presenting for Antiretroviral Therapy in Malawi
Authors
Bedell, R AAnderson, 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
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, ScotlandIssue Date
2011-06-22Submitted date
2011-12-06
Metadata
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PLoS OneAbstract
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.Publisher
Public Library of Science (PLoS)Additional Links
http://dx.plos.org/10.1371/journal.pone.0039347Type
ArticleLanguage
enISSN
1932-6203ae974a485f413a2113503eed53cd6c53
10.1371/journal.pone.0039347