Impact of human immunodeficiency virus infection on the clinical presentation and outcome of community-acquired pneumonia in hospitalized Nigerian adults: a multicenter case–control study

Iroezindu, Michael; Mbata, G C; Onyedum, Cajetan C; Chima, E I; Isiguzo, Godsent

doi:10.1016/j.bjid.2014.08.003

Cited by 2 publications

(2 citation statements)

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“…The observed prevalence was similar to that in a study by Mateyo et al in severely immunosuppressed patients with HIV [9]. TB presenting as acute pneumonia is a known phenomenon in sub-Saharan African, where overall TB prevalence is influenced by the high burden of HIV [3,7,10,17,18]. Previous studies show rates of TB in non-HIV infected persons in sub-Saharan Africa as high as 35% [10].…”

Section: Discussionsupporting

confidence: 83%

Aetiology and prognosis of community-acquired pneumonia at the Adult University Teaching Hospital in Zambia

et al. 2022

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Background Community-acquired pneumonia (CAP) is a frequent cause of death worldwide, and in sub-Saharan Africa particularly. Human immunodeficiency virus infection (HIV) and tuberculosis (TB) influence pathogen distribution in patients with CAP. Previous studies in sub-Saharan Africa have shown different frequencies of respiratory pathogens and antibiotic susceptibility compared to studies outside Africa. This study aimed to investigate the aetiology, presentation, and treatment outcomes of community-acquired pneumonia in adults at the University Teaching Hospital in Lusaka, Zambia. Materials and methods Three-hundred-and-twenty-seven patients were enrolled at the University Teaching Hospital in Lusaka between March 2018 and December 2018. Clinical characteristics and laboratory data were collected. Sputum samples were tested by microscopy, other TB diagnostics, and bacterial cultures. Results The commonest presenting complaint was cough (96%), followed by chest pain (60.6%), fever (59.3%), and breathlessness (58.4%). The most common finding on auscultation of the lungs was chest crackles (51.7%). Seventy percent of the study participants had complaints lasting at least a week before enrolment. The prevalence of HIV was 71%. Sputum samples were tested for 286 patients. The diagnostic yield was 59%. The most common isolate was Mycobacterium tuberculosis (20%), followed by Candida species (18%), Klebsiella pneumoniae (12%), and Pseudomonas aeruginosa (7%). Streptococcus pneumoniae was isolated in only four patients. There were no statistically significant differences between the rates of specific pathogens identified in HIV-infected patients compared with the HIV-uninfected. Thirty-day mortality was 30%. Patients with TB had higher 30-day mortality than patients without TB (p = 0.047). Conclusion Mycobacterium tuberculosis was the most common cause of CAP isolated in adults at the University Teaching Hospital in Lusaka, Zambia. Gram-negative organisms were frequently isolated. A high mortality rate was observed, as 30% of the followed-up study population had died after 30 days.

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Section: Discussionsupporting

confidence: 83%

Aetiology and prognosis of community-acquired pneumonia at the Adult University Teaching Hospital in Zambia

et al. 2022

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“…Third, advanced HIV-related immunosuppression remains an important predictor of mortality in settings with a high HIV burden. This finding is not entirely surprising because advanced HIV-related immunosuppression is associated with opportunistic diseases such as PcP and pKS which contribute to the increase in mortality due to LRTI 25,26 . Notably, only one-third of the HIV-positive participants in our study were on ART at hospitalization, a proportion that did not substantially change at two months.…”

Section: Discussionmentioning

confidence: 96%

Predictors of Mortality Among Hospitalized Patients With Lower Respiratory Tract Infections in a High HIV Burden Setting

Worodria

Chang

Andama

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction Lower respiratory tract infections (LRTIs) are a leading cause of mortality in sub-Saharan Africa. Triaging identifies patients at high-risk of death but laboratory tests proposed for use in severity-of-illness scores are not readily available, limiting their clinical use. Our objective was to determine whether baseline characteristics in hospitalized participants with LRTI predicted increased risk of death. Methods This was a secondary analysis from the MIND-IHOP cohort of adults hospitalized with LRTI who underwent standardized investigations and treatment. The primary outcome was all-cause mortality at two months. Predictors of mortality were determined using multiple logistic regression. Results Of 1887 hospitalized participants with LRTI, 372 (19.7%) died. The median participant age was 34.3 years (Interquartile Range, IQR, 28.0–43.3 years), 978 (51.8%) were men, and 1192 (63.2%) were HIV-positive with median CD4 counts of 81 cells/µL (IQR 21–226 cells/µL). Seven hundred eleven (37.7%) participants had a microbiologically confirmed diagnosis. Temperature <35.5ºC (aOR=1.77, 95% CI=1.20–2.60; p=0.004), heart rate >120/minute (aOR=1.82, 95% CI=1.37–2.43; p<0.0001), oxygen saturation <90% (aOR=2.74, 95% CI=1.97–3.81; p<0.0001), being bed-bound (aOR=1.88, 95% CI=1.47–2.41; p<0.0001) and being HIV-positive (aOR=1.49, 95%CI=1.14–1.94; p=0.003) were independently associated with mortality at two months. Conclusions Having temperature <35.5°C, heart rate >120/minute, hypoxia; being HIV positive and bed-bound independently predicts mortality in participants hospitalized with LRTI. These readily-available characteristics could be used to triage patients with LRTI in low-income settings. Providing adequate oxygen, adequate intravenous fluids; and early antiretroviral therapy (in people living with HIV/AIDS) may be life-saving in hospitalized patients with LRTI.

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Impact of human immunodeficiency virus infection on the clinical presentation and outcome of community-acquired pneumonia in hospitalized Nigerian adults: a multicenter case–control study

Cited by 2 publications

References 5 publications

Aetiology and prognosis of community-acquired pneumonia at the Adult University Teaching Hospital in Zambia

Aetiology and prognosis of community-acquired pneumonia at the Adult University Teaching Hospital in Zambia

Predictors of Mortality Among Hospitalized Patients With Lower Respiratory Tract Infections in a High HIV Burden Setting

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