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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Non-typhoidal salmonella bacteraemia among HIV-infected Malawian adults: High mortality and frequent recrudescence
AIDS, Volume 16, No. 12, Year 2002
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Description
Objective: Non-typhoidal salmonella (NTS) bacteraemia is a common, recurrent illness in HIV-infected African adults. We aimed to describe the presentation and outcome of NTS bacteraemia, the pattern of recurrence, and to determine whether recurrence results from re-infection or recrudescence. Design: One hundred consecutive adult inpatients with NTS bacteraemia in Blantyre, Malawi, were treated with chloramphenicol. Survivors were prospectively followed to detect bacteraemic recurrence. Methods: Index and recurrent isolates were typed by antibiogram, pulsed-field gel electrophoresis and plasmid analysis to distinguish recrudescence from re-infection. Results: Inpatient mortality was 47%, and 1-year mortality was 77%. A total of 77 out of 78 cases were HIV positive. Anaemia was associated with inpatient death, and several features of AIDS were associated with poor outpatient survival. Among survivors, 43% (19/44) had a first recurrence of NTS bacteraemia at 23-186 days. Among these, 26% (5/19) developed multiple recurrences up to 245 days. No recurrence was seen after 245 days, despite follow-up for up to 609 days (median 214). Suppurative infections were not found at presentation, and were only seen twice at recurrence. Index and recurrent paired isolates were identical by phenotyping and genotyping, consistent with recrudescence, rather than re-infection. Conclusion: NTS bacteraemia has a high mortality (47%) and recurrence (43%) rate in HIV-infected African adults. Recurrence is caused by recrudescence rather than reinfection. As focal infections were rarely found, recrudescence may often be a consequence of intracellular tissue sequestration. There is an urgent need for improved primary treatment and secondary prophylaxis in Africa. © 2002 Lippincott Williams & Wilkins.
Authors & Co-Authors
Gordon, Melita A.
Malawi, Zomba
University of Malawi
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Banda, Hastings Thomas
Malawi, Zomba
University of Malawi
Gondwe, Macpherson
Malawi, Zomba
University of Malawi
Gordon, Stephen B.
Malawi, Zomba
University of Malawi
Boeree, Martin Johan
Malawi, Zomba
University of Malawi
Walsh, Amanda L.
Malawi, Zomba
University of Malawi
Corkill, John Edward
United Kingdom, Liverpool
University of Liverpool
Hart, Charles Anthony
United Kingdom, Liverpool
University of Liverpool
Gilks, Charles F.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Molyneux, Malcolm Edward
Malawi, Zomba
University of Malawi
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Statistics
Citations: 289
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1097/00002030-200208160-00009
Research Areas
Infectious Diseases
Study Design
Cohort Study
Study Locations
Malawi