Show simple item record

Bacteremic disseminated tuberculosis in sub-saharan Africa: a prospective cohort study.

dc.contributor.author Crump, John A
dc.contributor.author Ramadhani, Habib O
dc.contributor.author Morrissey, Anne B
dc.contributor.author Saganda, Wilbrod
dc.contributor.author Mwako, Mtumwa S
dc.contributor.author Yang, Lan-Yan
dc.contributor.author Chow, Shein-Chung
dc.contributor.author Njau, Boniface N
dc.contributor.author Mushi, Godfrey S
dc.contributor.author Maro, Venance P
dc.contributor.author Reller, L Barth
dc.contributor.author Bartlett, John A
dc.coverage.spatial United States
dc.date.accessioned 2017-03-02T19:24:09Z
dc.date.available 2017-03-02T19:24:09Z
dc.date.issued 2012-07
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/22511551
dc.identifier cis409
dc.identifier.uri https://hdl.handle.net/10161/13794
dc.description.abstract BACKGROUND: Disseminated tuberculosis is a major health problem in countries where generalized human immunodeficiency virus (HIV) infection epidemics coincide with high tuberculosis incidence rates; data are limited on patient outcomes beyond the inpatient period. METHODS: We enrolled consecutive eligible febrile inpatients in Moshi, Tanzania, from 10 March 2006 through 28 August 2010; those with Mycobacterium tuberculosis bacteremia were followed up monthly for 12 months. Survival, predictors of bacteremic disseminated tuberculosis, and predictors of death were assessed. Antiretroviral therapy (ART) and tuberculosis treatment were provided. RESULTS: A total of 508 participants were enrolled; 29 (5.7%) had M. tuberculosis isolated by blood culture. The median age of all study participants was 37.4 years (range, 13.6-104.8 years). Cough lasting >1 month (odds ratio [OR], 13.5; P< .001), fever lasting >1 month (OR, 7.8; P = .001), weight loss of >10% (OR, 10.0; P = .001), lymphadenopathy (OR 6.8; P = .002), HIV infection (OR, undefined; P < .001), and lower CD4 cell count and total lymphocyte count were associated with bacteremic disseminated tuberculosis. Fifty percent of participants with M. tuberculosis bacteremia died within 36 days of enrollment. Lower CD4 cell count (OR, 0.88; P = .049) and lower total lymphocyte count (OR, 0.76; P = .050) were associated with death. Magnitude of mycobacteremia tended to be higher among those with lower CD4 cell counts, but did not predict death. CONCLUSIONS: In the era of free ART and access to tuberculosis treatment, almost one half of patients with M. tuberculosis bacteremia may die within a month of hospitalization. Simple clinical assessments can help to identify those with the condition. Advanced immunosuppression predicts death. Efforts should focus on early diagnosis and treatment of HIV infection, tuberculosis, and disseminated disease.
dc.language eng
dc.publisher Oxford University Press (OUP)
dc.relation.ispartof Clin Infect Dis
dc.relation.isversionof 10.1093/cid/cis409
dc.subject AIDS-Related Opportunistic Infections
dc.subject Adolescent
dc.subject Adult
dc.subject Aged
dc.subject Aged, 80 and over
dc.subject Anti-HIV Agents
dc.subject Antitubercular Agents
dc.subject Bacteremia
dc.subject Cohort Studies
dc.subject Female
dc.subject Follow-Up Studies
dc.subject Humans
dc.subject Male
dc.subject Middle Aged
dc.subject Mycobacterium tuberculosis
dc.subject Prospective Studies
dc.subject Survival Analysis
dc.subject Tanzania
dc.subject Time Factors
dc.subject Treatment Outcome
dc.subject Tuberculosis
dc.subject Young Adult
dc.title Bacteremic disseminated tuberculosis in sub-saharan Africa: a prospective cohort study.
dc.type Journal article
duke.contributor.id Crump, John A|0231646
duke.contributor.id Chow, Shein-Chung|0378427
duke.contributor.id Reller, L Barth|0022179
duke.contributor.id Bartlett, John A|0058484
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/22511551
pubs.begin-page 242
pubs.end-page 250
pubs.issue 2
pubs.organisational-group Basic Science Departments
pubs.organisational-group Biostatistics & Bioinformatics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Cancer Institute
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Duke Science & Society
pubs.organisational-group Global Health Institute
pubs.organisational-group Initiatives
pubs.organisational-group Institutes and Centers
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Infectious Diseases
pubs.organisational-group Pathology
pubs.organisational-group School of Medicine
pubs.organisational-group School of Nursing
pubs.organisational-group School of Nursing - Secondary Group
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published
pubs.volume 55
dc.identifier.eissn 1537-6591


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record