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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Mycobacterium tuberculosis Bacteremia in a Cohort of HIV-Infected Patients Hospitalized with Severe Sepsis in Uganda-High Frequency, Low Clinical Sand Derivation of a Clinical Prediction Score
PLoS ONE, Volume 8, No. 8, Article e70305, Year 2013
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Description
Background: When manifested as Mycobacterium tuberculosis (MTB) bacteremia, disseminated MTB infection clinically mimics other serious blood stream infections often hindering early diagnosis and initiation of potentially life-saving anti-tuberculosis therapy. In a cohort of hospitalized HIV-infected Ugandan patients with severe sepsis, we report the frequency, management and outcomes of patients with MTB bacteremia and propose a risk score based on clinical predictors of MTB bacteremia. Methods: We prospectively enrolled adult patients with severe sepsis at two Ugandan hospitals and obtained blood cultures for MTB identification. Multivariable logistic regression modeling was used to determine predictors of MTB bacteremia and to inform the stratification of patients into MTB bacteremia risk categories based on relevant patient characteristics. Results: Among 368 HIV-infected patients with a syndrome of severe sepsis, eighty-six (23%) had MTB bacteremia. Patients with MTB bacteremia had a significantly lower median CD4 count (17 vs 64 lymphocytes/mm3, p<0.001) and a higher 30-day mortality (53% vs 32%, p = 0.001) than patients without MTB bacteremia. A minority of patients with MTB bacteremia underwent standard MTB diagnostic testing (24%) or received empiric anti-tuberculosis therapy (15%). Independent factors associated with MTB bacteremia included male sex, increased heart rate, low CD4 count, absence of highly active anti-retroviral therapy, chief complaint of fever, low serum sodium and low hemoglobin. A risk score derived from a model containing these independent predictors had good predictive accuracy [area under the curve = 0.85, 95% CI 0.80-0.89]. Conclusions: Nearly 1 in 4 adult HIV-infected patients hospitalized with severe sepsis in 2 Ugandan hospitals had MTB bacteremia. Among patients in whom MTB was suspected, standard tests for diagnosing pulmonary MTB were inaccurate for correctly classifying patients with or without bloodstream MTB infection. A MTB bacteremia risk score can improve early diagnosis of MTB bacteremia particularly in settings with increased HIV and MTB co-infection. © 2013 Jacob et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3734073/bin/pone.0070305.s001.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3734073/bin/pone.0070305.s002.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3734073/bin/pone.0070305.s003.docx
Authors & Co-Authors
Jacob, Shevin T.
United States, Seattle
University of Washington
Pavlinac, Patricia B.
United States, Seattle
University of Washington
Nakiyingi, Lydia
Uganda, Kampala
Makerere University
Banura, Patrick
Uganda, Masaka
Masaka Regional Referral Hospital
Baeten, Jared M.
United States, Seattle
University of Washington
Morgan, Karen
Uganda
Jcrc tb Laboratory
Magaret, Amalia Meier
United States, Seattle
University of Washington
United States, Seattle
Fred Hutchinson Cancer Research Center
Manabe, Yukari C.
United States, Baltimore
Johns Hopkins University
Reynolds, Steven James
United States, Baltimore
Johns Hopkins University
Uganda, Kalisizo
Rakai Health Sciences Program
United States, Bethesda
National Institutes of Health Nih
Liles, Wayne Conrad
United States, Seattle
University of Washington
Wald, Anna
United States, Seattle
University of Washington
Uganda, Kalisizo
Rakai Health Sciences Program
Joloba, Moses Lutaakome
Uganda, Kampala
Makerere University
Mayanja-Kizza, Harriet
Uganda, Kampala
Makerere University
Scheld, William Michael
United States, Charlottesville
University of Virginia
Statistics
Citations: 59
Authors: 14
Affiliations: 9
Identifiers
Doi:
10.1371/journal.pone.0070305
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
Uganda
Participants Gender
Male