Bacteremic Disseminated Tuberculosis in Sub-Saharan Africa: A Prospective Cohort Study

Abstract

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.

Macrophage migration inhibitory factor (MIF) is a critical mediator of the innate immune response to Mycobacterium tuberculosis

“…Consistent with the published geographic stratification of MIF polymorphisms, our cohort's CATT distribution was distinct from the other populations in which MIF genotypes have been studied. Disseminated M. tuberculosis is well described in populations with high HIV seroprevalence and depressed CD4 T-cell counts and is associated with a high risk of mortality (54,55). Although the importance of CD4 T-cell function in TB immunity is well established, the contribution of innate immunity to TB outcome also has been described in this group (56,57).…”

Bloodstream infections in HIV-infected patients

“…Several attempts have been made to outline the profile of the typical patients at risk for mycobacterial BSI. They are usually less likely to receive cART, 42 with significantly lower median CD4 cell counts, 42,54,60 higher HIV RNA, 54 fever and cough lasting for > 1 month, 60 weight loss of >10 % 60 and presence of lymphadenopathies. 60 Moreover, they were more likely to have community-acquired infections, were younger compared to patients with bacterial BSI 54 and their hemoglobin values were below the median levels.…”

“…They are usually less likely to receive cART, 42 with significantly lower median CD4 cell counts, 42,54,60 higher HIV RNA, 54 fever and cough lasting for > 1 month, 60 weight loss of >10 % 60 and presence of lymphadenopathies. 60 Moreover, they were more likely to have community-acquired infections, were younger compared to patients with bacterial BSI 54 and their hemoglobin values were below the median levels. 56 Jacob et al even proposed a score based on male sex, increased heart rate, low CD4 cell count, absence of cART, fever, low serum sodium and low hemoglobin.…”

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

“…on peripheral blood smear ( 500 trophozoites/μL), 10,11 nucleic acid detection in serum (dengue, chikungunya, or flaviviruses), 19 serum antigen detection (Cryptococcus neoformans 1:8), 21 urine antigen detection (Histoplasma capsulatum, 20 Streptococcus pneumoniae, Legionella pneumophila serogroup 1), 10,11 4-fold rise between acute and convalescent serology (microscopic agglutination tests [MAT] for Brucella spp., 18 and Leptospira spp., 17 and immunofluorescent antibody [IFA] for Coxiella burnetii, Rickettsia conorii, and Rickettsia typhi), 16 or isolation of clinically relevant bacteria, mycobacteria, or fungi from blood culture. 10,11 Illness was attributed to tuberculosis based solely on isolation of Mycobacterium tuberculosis complex from blood culture (i.e., bacteremic disseminated tuberculosis), 22 and not based on a clinical diagnosis of tuberculosis or positive acid-fast bacilli smear or culture of respiratory specimens, which were not collected as part of the febrile illness cohort study.…”