Etiologies of illness among patients meeting integrated management of adolescent and adult illness district clinician manual criteria for severe infections in northern Tanzania: implications for empiric antimicrobial therapy.
Abstract
We describe the laboratory-confirmed etiologies of illness among participants in a
hospital-based febrile illness cohort study in northern Tanzania who retrospectively
met Integrated Management of Adolescent and Adult Illness District Clinician Manual
(IMAI) criteria for septic shock, severe respiratory distress without shock, and severe
pneumonia, and compare these etiologies against commonly used antimicrobials, including
IMAI recommendations for emergency antibacterials (ceftriaxone or ampicillin plus
gentamicin) and IMAI first-line recommendations for severe pneumonia (ceftriaxone
and a macrolide). Among 423 participants hospitalized with febrile illness, there
were 25 septic shock, 37 severe respiratory distress without shock, and 109 severe
pneumonia cases. Ceftriaxone had the highest potential utility of all antimicrobials
assessed, with responsive etiologies in 12 (48%) septic shock, 5 (14%) severe respiratory
distress without shock, and 19 (17%) severe pneumonia illnesses. For each syndrome
17-27% of participants had etiologic diagnoses that would be non-responsive to ceftriaxone,
but responsive to other available antimicrobial regimens including amphotericin for
cryptococcosis and histoplasmosis; anti-tuberculosis therapy for bacteremic disseminated
tuberculosis; or tetracycline therapy for rickettsioses and Q fever. We conclude that
although empiric ceftriaxone is appropriate in our setting, etiologies not explicitly
addressed in IMAI guidance for these syndromes, such as cryptococcosis, histoplasmosis,
and tetracycline-responsive bacterial infections, were common.
Type
Journal articleSubject
Acute DiseaseAdolescent
Adult
Aged
Aged, 80 and over
Amphotericin B
Ampicillin
Anti-Infective Agents
Bacterial Infections
Ceftriaxone
Child
Cohort Studies
Cryptococcosis
Emergencies
Female
Gentamicins
Histoplasmosis
Humans
Infection
Macrolides
Male
Microbial Sensitivity Tests
Middle Aged
Pneumonia, Bacterial
Respiratory Distress Syndrome, Adult
Shock, Septic
Tanzania
Tetracycline
Young Adult
Permalink
https://hdl.handle.net/10161/13771Published Version (Please cite this version)
10.4269/ajtmh.14-0496Publication Info
Rubach, Matthew P; Maro, Venance P; Bartlett, John A; & Crump, John A (2015). Etiologies of illness among patients meeting integrated management of adolescent and
adult illness district clinician manual criteria for severe infections in northern
Tanzania: implications for empiric antimicrobial therapy. Am J Trop Med Hyg, 92(2). pp. 454-462. 10.4269/ajtmh.14-0496. Retrieved from https://hdl.handle.net/10161/13771.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
John Alexander Bartlett
Professor of Medicine
My clinical investigation is focused on the pathogenesis and treatment of HIV infection
and its complications, especially in resource-limited settings. Key Words: HIV infection,
AIDS, treatment strategies, treatment failure, co-infections, resource-limited settings
John Andrew Crump
Adjunct Professor in the Department of Medicine
I am based in northern Tanzania where I am Site Leader for Duke University’s
collaborative research program based at Kilimanjaro Christian Medical Centre and Director
of Tanzania Operations for the Duke Global Health Institute. I oversee the design
and implementation of research studies on infectious diseases, particularly febrile
illness, invasive bacterial disease, HIV-associated opportunistic infections, clinical
trials of antiretroviral therapy and prevention of mother-to-child tr
Matthew P. Rubach
Associate Professor of Medicine
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info