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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The bacteraemia of disseminated tuberculosis among HIV-infected patients with prolonged fever in Tanzania
Scandinavian Journal of Infectious Diseases, Volume 43, No. 9, Year 2011
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Description
Background: Disseminated tuberculosis (TB) is a common cause of death among human immunodeficiency virus (HIV)-infected patients in developing countries. Blood culture offers a potential means to diagnose disseminated TB, but optimal blood culture methods have not been studied. Methods: Two hundred and fifty-eight HIV-infected patients hospitalized in Tanzania with ≥2 weeks fever or cough had diagnostic studies for TB: 3 sputum samples for acid-fast bacilli smear and culture; 40 ml of blood for culture, randomized 1:1 to 40 ml × 1, or 20 ml × 2 collected 1224 h apart. Blood was processed using automated MB BacT ® broth and manual Isolator ® lysis-centrifugation agar. Mortality was assessed at 2 months. Results: TB was confirmed in 83 (32%) of 258 patients: by sputum only in 42 (51%, median CD4 = 72 cells/μl), blood only in 15 (18%, median CD4 = 44 cells/μl), and in sputum and blood in 26 (31%, median CD4 = 12 cells/μl). Blood was positive in 21 (16%) for 40 ml × 1 vs 20 (15%) for 20 ml × 1 (p = 0.83) vs 20 (16%) for 20 ml × 2 (p = 0.97). MB BacT was positive in 31 (76%) and Isolator was positive in 20 (49%) of 41 samples (p = 0.01). The mean colony-forming units/ml was 8 (range 314). Twenty-one (51%) patients with disseminated TB died; median survival was 6 days (range 058). Conclusions: Disseminated TB in HIV is characterized by persistent bacteraemia, delayed microbiological detection, and high mortality. Twenty millilitres of blood processed by automated broth is the optimal culture method to detect disseminated TB. Empiric TB therapy is warranted for HIV-infected patients from TB-endemic countries with prolonged cough or fever. © 2011 Informa Healthcare.
Authors & Co-Authors
Munseri, Patricia Jane
India
Muhimbili University of Health and Allied Sciences
Sweden, Stockholm
Karolinska Institutet
Talbot, Elizabeth A.S.
United States, Hanover
Geisel School of Medicine at Dartmouth
Switzerland, Geneva
Foundation for Innovative new Diagnostics, Switzerland
Bakari, Muhammad
India
Muhimbili University of Health and Allied Sciences
Matee, Mecky Isaac N.
India
Muhimbili University of Health and Allied Sciences
Teixeira, J. Pedro
United States, Hanover
Geisel School of Medicine at Dartmouth
von Reyn, Charles Fordham
United States, Hanover
Geisel School of Medicine at Dartmouth
Statistics
Citations: 21
Authors: 6
Affiliations: 4
Identifiers
Doi:
10.3109/00365548.2011.577802
ISSN:
16511980
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
Tanzania