Prevalence and Factors Associated With Mycobacteremia Among Febrile HIV Infected Patients in Mwanza Tanzania
Paulina Manyiri [Female]
Prevalence and Factors Associated With Mycobacteremia Among Febrile HIV Infected Patients in Mwanza Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : ©2017 - xiv; 71 Pages Includes References and Appendices
Abstract:
Background: Tuberculosis remains an important public health concern in the world. It is the common preventable opportunistic infection that causes high mortality in human immunodeficiency virus infected patients. Disseminated tuberculosis remains the common cause of blood stream infections in patients with human immunodeficiency virus and tuberculosis co-infection especially in developing countries. Diagnosis of mycobacteteremia is challenging especially in developing countries due to limited microbiology resources and trained staff.
Objective: To determine prevalence and factors associated with mycobacteremia tuberculosis in febrile human immunodeficiency virus infected patients in Mwanza, Tanzania.
Methods: This longitudinal study was conducted at Sekou Toure hospital and Bugando Medical Centre. A total of 154 patients were enrolled in the study. Blood samples, sputum for acid fast bacilli and chest radiograph were obtained from all patients. Blood culture was done on BACTEC Myco/F Lytic bottles, then sub-cultured into Lowenstein Jensen media for identification of mycobacteria. In addition sputum samples were tested to detect MTB using Auramine staining and Xpert MTB/RIF assay. Data were analyzed using STATA version 13.
Results: A total of 154 patients’ age 14-70 years with a mean age of 41.5±12.2 were enrolled in the study. Female formed the majority 93 (60%) of the study participants. The prevalence of mycobacteremia was 3.3% (95% CI; 0.4 – 5.9). Other bacteria were detected in 13(8.4%) of the patients. Common bacteria identified were Pseudomonas aeruginosa, Echerichia coli, Staphlococcus aureus, Acinetobacter spp., Klebsiella pneumoniae. Factors found to be significantly associated with mycobacteremia were lower mean age (p=0.03), HIV infection diagnosed within one year or less (p=0.005), not taking HAART (p=0.031), higher respiratory rate (p=0.003) and low CD4+ count (p=0.002). Factors significantly associated with 14-day in hospital mortality were male sex (p=0.031), advanced HV infection (p=<0.001), poor ART adherence (p<0.001), diarrhea (p=0.002), self-report weight loss (p=0.034), low platelet count p(<0.001), low CD4+ (p=0.002) and mycobacteremia (p=0.007).
Conclusion and Recommendations: The prevalence of mycobacteremia was low, however it was significantly associated with mortality. Furthermore, low CD4 count, not taking HAART, recent diagnosis of HIV infection of less than a year were significantly associated with mycobacteremia. Mycobacteremia should be considered as alternate diagnosis in high risk febrile HIV infected individuals in order to reduce associated morbidity and mortality.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Internal Medicine
Prevalence and Factors Associated With Mycobacteremia Among Febrile HIV Infected Patients in Mwanza Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : ©2017 - xiv; 71 Pages Includes References and Appendices
Abstract:
Background: Tuberculosis remains an important public health concern in the world. It is the common preventable opportunistic infection that causes high mortality in human immunodeficiency virus infected patients. Disseminated tuberculosis remains the common cause of blood stream infections in patients with human immunodeficiency virus and tuberculosis co-infection especially in developing countries. Diagnosis of mycobacteteremia is challenging especially in developing countries due to limited microbiology resources and trained staff.
Objective: To determine prevalence and factors associated with mycobacteremia tuberculosis in febrile human immunodeficiency virus infected patients in Mwanza, Tanzania.
Methods: This longitudinal study was conducted at Sekou Toure hospital and Bugando Medical Centre. A total of 154 patients were enrolled in the study. Blood samples, sputum for acid fast bacilli and chest radiograph were obtained from all patients. Blood culture was done on BACTEC Myco/F Lytic bottles, then sub-cultured into Lowenstein Jensen media for identification of mycobacteria. In addition sputum samples were tested to detect MTB using Auramine staining and Xpert MTB/RIF assay. Data were analyzed using STATA version 13.
Results: A total of 154 patients’ age 14-70 years with a mean age of 41.5±12.2 were enrolled in the study. Female formed the majority 93 (60%) of the study participants. The prevalence of mycobacteremia was 3.3% (95% CI; 0.4 – 5.9). Other bacteria were detected in 13(8.4%) of the patients. Common bacteria identified were Pseudomonas aeruginosa, Echerichia coli, Staphlococcus aureus, Acinetobacter spp., Klebsiella pneumoniae. Factors found to be significantly associated with mycobacteremia were lower mean age (p=0.03), HIV infection diagnosed within one year or less (p=0.005), not taking HAART (p=0.031), higher respiratory rate (p=0.003) and low CD4+ count (p=0.002). Factors significantly associated with 14-day in hospital mortality were male sex (p=0.031), advanced HV infection (p=<0.001), poor ART adherence (p<0.001), diarrhea (p=0.002), self-report weight loss (p=0.034), low platelet count p(<0.001), low CD4+ (p=0.002) and mycobacteremia (p=0.007).
Conclusion and Recommendations: The prevalence of mycobacteremia was low, however it was significantly associated with mortality. Furthermore, low CD4 count, not taking HAART, recent diagnosis of HIV infection of less than a year were significantly associated with mycobacteremia. Mycobacteremia should be considered as alternate diagnosis in high risk febrile HIV infected individuals in order to reduce associated morbidity and mortality.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Internal Medicine