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.

dc.contributor.author

Rubach, Matthew P

dc.contributor.author

Maro, Venance P

dc.contributor.author

Bartlett, John A

dc.contributor.author

Crump, John A

dc.coverage.spatial

United States

dc.date.accessioned

2017-03-02T19:07:31Z

dc.date.available

2017-03-02T19:07:31Z

dc.date.issued

2015-02

dc.description.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.

dc.identifier

https://www.ncbi.nlm.nih.gov/pubmed/25385866

dc.identifier

ajtmh.14-0496

dc.identifier.eissn

1476-1645

dc.identifier.uri

https://hdl.handle.net/10161/13771

dc.language

eng

dc.publisher

American Society of Tropical Medicine and Hygiene

dc.relation.ispartof

Am J Trop Med Hyg

dc.relation.isversionof

10.4269/ajtmh.14-0496

dc.subject

Acute Disease

dc.subject

Adolescent

dc.subject

Adult

dc.subject

Aged

dc.subject

Aged, 80 and over

dc.subject

Amphotericin B

dc.subject

Ampicillin

dc.subject

Anti-Infective Agents

dc.subject

Bacterial Infections

dc.subject

Ceftriaxone

dc.subject

Child

dc.subject

Cohort Studies

dc.subject

Cryptococcosis

dc.subject

Emergencies

dc.subject

Female

dc.subject

Gentamicins

dc.subject

Histoplasmosis

dc.subject

Humans

dc.subject

Infection

dc.subject

Macrolides

dc.subject

Male

dc.subject

Microbial Sensitivity Tests

dc.subject

Middle Aged

dc.subject

Pneumonia, Bacterial

dc.subject

Respiratory Distress Syndrome, Adult

dc.subject

Shock, Septic

dc.subject

Tanzania

dc.subject

Tetracycline

dc.subject

Young Adult

dc.title

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.

dc.type

Journal article

pubs.author-url

https://www.ncbi.nlm.nih.gov/pubmed/25385866

pubs.begin-page

454

pubs.end-page

462

pubs.issue

2

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Duke

pubs.organisational-group

Duke Cancer 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

92

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
AmJTropMedHyg_IMAI.pdf
Size:
645.62 KB
Format:
Adobe Portable Document Format