SETTING: Adult medical wards of a central hospital in Blantyre, Malawi. OBJECTIVE: To measure the prevalence and outcome of mycobacteraemia in febrile hospitalised adults, and to determine what proportion could be identified using routine methods; to assess clinical indicators of mycobacteraemia, and the usefulness of a diagnostic trial of anti-tuberculosis treatment. DESIGN: We prospectively examined adults admitted with fever or a history of fever. All had blood cultured for bacteria and mycobacteria, chest X-ray and sputum smears. FINDINGS: Mycobacterium tuberculosis was the commonest cause of blood stream infection (BSI), affecting 57 of 344 patients (17%). In 44 (77%) patients with mycobacteraemia, TB was identified using routine investigations; it was not suspected in six (11%). Strong clinical indicators of mycobacteraemia were anaemia, HIV seropositivity, cough, chronic fever and a clinical diagnosis of AIDS on the day of admission. Of nine patients selected for a therapeutic trial of tuberculosis (TB) treatment, six had mycobacteraemia, of whom five died during the trial. Mortality on short-course chemotherapy, on the TB ward after 1 month was similar whether patients had mycobacteremia (21%) or not (32%). CONCLUSION: TB can be identified with routine methods in most patients with mycobacteraemia. If treated, mycobacteraemia has as good an early outcome as TB without mycobacteraemia. Strengthening of basic facilities is likely to improve detection and treatment of mycobacterial disease.
SETTING: Adult medical wards of a central hospital in Blantyre, Malawi. OBJECTIVE: To measure the prevalence and outcome of mycobacteraemia in febrile hospitalised adults, and to determine what proportion could be identified using routine methods; to assess clinical indicators of mycobacteraemia, and the usefulness of a diagnostic trial of anti-tuberculosis treatment. DESIGN: We prospectively examined adults admitted with fever or a history of fever. All had blood cultured for bacteria and mycobacteria, chest X-ray and sputum smears. FINDINGS:Mycobacterium tuberculosis was the commonest cause of blood stream infection (BSI), affecting 57 of 344 patients (17%). In 44 (77%) patients with mycobacteraemia, TB was identified using routine investigations; it was not suspected in six (11%). Strong clinical indicators of mycobacteraemia were anaemia, HIV seropositivity, cough, chronic fever and a clinical diagnosis of AIDS on the day of admission. Of nine patients selected for a therapeutic trial of tuberculosis (TB) treatment, six had mycobacteraemia, of whom five died during the trial. Mortality on short-course chemotherapy, on the TB ward after 1 month was similar whether patients had mycobacteremia (21%) or not (32%). CONCLUSION: TB can be identified with routine methods in most patients with mycobacteraemia. If treated, mycobacteraemia has as good an early outcome as TB without mycobacteraemia. Strengthening of basic facilities is likely to improve detection and treatment of mycobacterial disease.
Authors: John A Crump; Marion J Tuohy; Anne B Morrissey; Habib O Ramadhani; Boniface N Njau; Venance P Maro; L Barth Reller; Gary W Procop Journal: J Clin Microbiol Date: 2011-10-26 Impact factor: 5.948
Authors: P B Pavlinac; E M Lokken; J L Walson; B A Richardson; J A Crump; G C John-Stewart Journal: Int J Tuberc Lung Dis Date: 2016-07 Impact factor: 2.373
Authors: John A Crump; Anne B Morrissey; Habib O Ramadhani; Boniface N Njau; Venance P Maro; L Barth Reller Journal: J Clin Microbiol Date: 2011-06-08 Impact factor: 5.948
Authors: John A Crump; Habib O Ramadhani; Anne B Morrissey; Wilbrod Saganda; Mtumwa S Mwako; Lan-Yan Yang; Shein-Chung Chow; Boniface N Njau; Godfrey S Mushi; Venance P Maro; L Barth Reller; John A Bartlett Journal: Clin Infect Dis Date: 2012-04-16 Impact factor: 9.079
Authors: Katherine D Gray; Coleen K Cunningham; Dana C Clifton; Isaac A Afwamba; Godfrey S Mushi; Levina J Msuya; John A Crump; Ann M Buchanan Journal: Pediatr Infect Dis J Date: 2013-07 Impact factor: 2.129