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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Clinical features and etiology of pneumonia in acid-fast bacillus sputum smear-negative HIV-infected patients hospitalized in Asia and Africa
AIDS, Volume 22, No. 11, Year 2008
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Description
Objectives: To determine the main causes of acid-fast bacillus sputum smear-negative pneumonia in Asian and African HIV-infected patients Design and Setting: A prospective multicenter study (ANRS 1260) of consecutive hospitalized patients in tertiary hospitals in Phnom Penh, Ho Chi Minh City, Bangui and Dakar. Intervention: Use of the same clinical, radiological and biological methods at the four sites; regular quality controls of participating laboratories; final review of medical records by experts. Similar criteria used to establish diagnoses. Results: In all 462 patients were enrolled, 291 in Asia and 171 in Africa. The median CD4 cell count was 25 cells/μl. Radiological opacities were diffuse in 42% of patients and localized in 45%. Fiberoptic bronchoscopy was performed in 354 patients, at similar rates in the four sites. A definite and/or probable diagnosis was obtained in 375 patients (81%). Pneumocystis jiroveci pneumonia, bacterial pneumonia, AFB sputum smear-negative tuberculosis and other infections (fungi, parasites, atypical mycobacteria) were diagnosed in respectively 47, 30, 17 and 12% of Asian patients and 3, 48, 26 and 5% of African patients. Conclusion: In South-east Asia, acid-fast bacillus smear-negative pneumonia is caused by a wide variety of pathogens. When possible, fiberoptic bronchoscopy must be performed rapidly if clinical data are not highly suggestive of bacterial pneumonia, Pneumocystis jiroveci pneumonia or tuberculosis. In contrast, in Africa, bacterial pneumonia and tuberculosis are responsible for the large majority of cases. Fiberoptic bronchoscopy should be restricted to patients with clinical and/or radiological findings not suggestive of bacterial pneumonia or tuberculosis, antibiotic failure, and three consecutive negative sputum smears. © 2008 Wolters Kluwer Health / Lippincott Williams & Wilkins.
Authors & Co-Authors
Vray, Muriel M.
France, Paris
Institut Pasteur, Paris
Germani, Yves
France, Paris
Institut Pasteur, Paris
Chan, Sarin
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Duc, Nguyenhong
Viet Nam, Ho Chi Minh City
Hôpital Phan Ngoc Thach
Sar, Borann
Cambodia, Phnom Penh
Institut Pasteur du Cambodge
Sarr, Fatoumata Diène
Senegal, Dakar
Institut Pasteur de Dakar
Bercion, Raymond
France, Paris
Institut Pasteur, Paris
Rahalison, Lila
France, Paris
Institut Pasteur, Paris
Maynard, Maryvonne
Viet Nam, Ho Chi Minh City
Pasteur Institute in ho Chi Minh City
LHer, Pierre
France, Bordeaux Armees
Hôpital Militaire Bouffard
Chartier, Loïc
France, Paris
Institut Pasteur, Paris
Mayaud, Charles Marie
France, Paris
Hôpital Tenon
Statistics
Citations: 33
Authors: 12
Affiliations: 7
Identifiers
Doi:
10.1097/QAD.0b013e3282fdf8bf
e-ISSN:
14735571
Research Areas
Infectious Diseases
Study Design
Randomised Control Trial
Cohort Study