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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Pneumococcal disease in HIV-infected Malawian adults: Acute mortality and long-term survival
AIDS, Volume 16, No. 10, Year 2002
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Description
Objective: HIV-infected patients in Africa are vulnerable to severe recurrent infection with Streptococcus pneumoniae, but no effective preventive strategy has been developed. We set out to determine which factors influence in-hospital mortality and long-term survival of Malawians with invasive pneumococcal disease. Design, setting and patients: Acute clinical features, inpatient mortality and long-term survival were described among consecutively admitted hospital patients with S. pneumoniae in the blood or cerebrospinal fluid. Factors associated with inpatient mortality were determined, and patients surviving to discharge were followed to determine their long-term outcome. Results: A total of 217 patients with pneumococcal disease were studied over an 18-month period. Among these, 158 out of 167 consenting to testing (95%) were HIV positive. Inpatient mortality was 65% for pneumococcal meningitis (n = 64), 20% for pneumococcaemic pneumonia (n = 92), 26% for patients with pneumococcaemia without localizing signs (n = 43), and 76% in patients with probable meningitis (n = 17). Lowered consciousness level, hypotension, and age exceeding 55 years at presentation were associated with inpatient death, but not long-term outcome in survivors. Hospital survivors were followed for a median of 414 days; 39% died in the community during the study period. Outpatient death was associated with multilobar chest signs, oral candidiasis, and severe anaemia as an inpatient. Conclusion: Most patients with pneumococcal disease in Malawi have HIV co-infection. They have severe disease with a high mortality rate. At discharge, all HIV-infected adults have a poor prognosis but patients with multilobar chest signs or anaemia are at particular risk. © 2002 Lippincott Williams & Wilkins.
Authors & Co-Authors
Gordon, Stephen B.
United Kingdom, Liverpool
University of Liverpool
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Chaponda, Mas E.
Malawi, Zomba
University of Malawi
Walsh, Amanda L.
United Kingdom, Liverpool
University of Liverpool
Whitty, Christopher J.M.
Malawi, Zomba
University of Malawi
Gordon, Melita A.
Malawi, Zomba
University of Malawi
Malawi, Blantyre
Malawi-liverpool-wellcome Trust Clinical Research Programme
Machili, C. Edward
Malawi, Zomba
University of Malawi
Gilks, Charles F.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Boeree, Martin Johan
Malawi, Zomba
University of Malawi
Kampondeni, Sam D.
Malawi, Zomba
University of Malawi
Read, Robert Charles
United Kingdom, Sheffield
The Sheffield Medical School
Molyneux, Malcolm Edward
United Kingdom, Liverpool
University of Liverpool
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Statistics
Citations: 72
Authors: 11
Affiliations: 5
Identifiers
Doi:
10.1097/00002030-200207050-00013
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
Malawi