Background: Knowledge of causes of sepsis in sub-Saharan Africa is limited. A better understanding of the microbiology of bloodstream infections could improve outcomes. Methods: We used a quantitative polymerase chain reaction (qPCR)-based TaqMan Array Card (TAC) to directly test for 43 targets from whole blood. We analyzed 336 cryopreserved specimens from adult Ugandans with sepsis enrolled in a multisite study; 84% were infected with human immunodeficiency virus. We compared qPCR TAC results with blood culture and determined the association of qPCR with study participant outcomes using logistic regression. Results: The most frequently detected targets were cytomegalovirus (CMV, n = 139, 41%), Mycobacterium tuberculosis (TB, n = 70, 21%), Plasmodium (n = 35, 10%), and Streptococcus pneumoniae (n = 31, 9%). Diagnostic performance varied by target with qPCR sensitivity averaging 61 ± 28% and specificity 98 ± 3% versus culture. In multivariable analysis, independent factors associated with in-hospital mortality included CMV viremia (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI], 1.8-5.5; p < .01) and TB qPCR-positivity, whether blood culture-positive (aOR 4.6, 95% CI, 2.1-10.0; p < .01) or blood culture-negative (aOR 2.9, 95% CI, 1.2-6.9; p = .02). Conclusions: Using qPCR TAC on direct blood specimens, CMV and TB were the most commonly identified targets and were independently associated with increased in-hospital mortality. qPCR TAC screening of blood for multiple targets may be useful to guide triage and treatment of sepsis in sub-Saharan Africa.
Background: Knowledge of causes of sepsis in sub-Saharan Africa is limited. A better understanding of the microbiology of bloodstream infections could improve outcomes. Methods: We used a quantitative polymerase chain reaction (qPCR)-based TaqMan Array Card (TAC) to directly test for 43 targets from whole blood. We analyzed 336 cryopreserved specimens from adult Ugandans with sepsis enrolled in a multisite study; 84% were infected with human immunodeficiency virus. We compared qPCR TAC results with blood culture and determined the association of qPCR with study participant outcomes using logistic regression. Results: The most frequently detected targets were cytomegalovirus (CMV, n = 139, 41%), Mycobacterium tuberculosis (TB, n = 70, 21%), Plasmodium (n = 35, 10%), and Streptococcus pneumoniae (n = 31, 9%). Diagnostic performance varied by target with qPCR sensitivity averaging 61 ± 28% and specificity 98 ± 3% versus culture. In multivariable analysis, independent factors associated with in-hospital mortality included CMV viremia (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI], 1.8-5.5; p < .01) and TB qPCR-positivity, whether blood culture-positive (aOR 4.6, 95% CI, 2.1-10.0; p < .01) or blood culture-negative (aOR 2.9, 95% CI, 1.2-6.9; p = .02). Conclusions: Using qPCR TAC on direct blood specimens, CMV and TB were the most commonly identified targets and were independently associated with increased in-hospital mortality. qPCR TAC screening of blood for multiple targets may be useful to guide triage and treatment of sepsis in sub-Saharan Africa.
Authors: Anand Kumar; Daniel Roberts; Kenneth E Wood; Bruce Light; Joseph E Parrillo; Satendra Sharma; Robert Suppes; Daniel Feinstein; Sergio Zanotti; Leo Taiberg; David Gurka; Aseem Kumar; Mary Cheang Journal: Crit Care Med Date: 2006-06 Impact factor: 7.598
Authors: Malavika Prabhu; William L Nicholson; Aubree J Roche; Gilbert J Kersh; Kelly A Fitzpatrick; Lindsay D Oliver; Robert F Massung; Anne B Morrissey; John A Bartlett; Jecinta J Onyango; Venance P Maro; Grace D Kinabo; Wilbrod Saganda; John A Crump Journal: Clin Infect Dis Date: 2011-08 Impact factor: 9.079
Authors: Paul Dark; Bronagh Blackwood; Simon Gates; Danny McAuley; Gavin D Perkins; Ronan McMullan; Claire Wilson; Daniel Graham; Kate Timms; Geoffrey Warhurst Journal: Intensive Care Med Date: 2014-11-22 Impact factor: 17.440
Authors: Holly M Biggs; Renee L Galloway; Duy M Bui; Annie B Morrissey; Venance P Maro; John A Crump Journal: Vector Borne Zoonotic Dis Date: 2013-05-10 Impact factor: 2.133
Authors: Laurent Papazian; Sami Hraiech; Samuel Lehingue; Antoine Roch; Laurent Chiche; Sandrine Wiramus; Jean-Marie Forel Journal: Intensive Care Med Date: 2015-09-30 Impact factor: 17.440
Authors: Shevin T Jacob; Christopher C Moore; Patrick Banura; Relana Pinkerton; David Meya; Pius Opendi; Steven J Reynolds; Nathan Kenya-Mugisha; Harriet Mayanja-Kizza; W Michael Scheld Journal: PLoS One Date: 2009-11-11 Impact factor: 3.240
Authors: Nicholas A Feasey; Padmapriya P Banada; William Howson; Derek J Sloan; Aaron Mdolo; Catharina Boehme; Geoffrey A Chipungu; Theresa J Allain; Robert S Heyderman; Elizabeth L Corbett; David Alland Journal: J Clin Microbiol Date: 2013-05-15 Impact factor: 5.948
Authors: Andrew A Adjei; Henry B Armah; Foster Gbagbo; Isaac Boamah; Clement Adu-Gyamfi; Isaac Asare Journal: BMC Infect Dis Date: 2008-08-18 Impact factor: 3.090
Authors: Donatus Bonphace Tsere; Gabriel Mkilema Shirima; Brian S Grundy; Scott K Heysell; Stellah G Mpagama; Shabani Ramadhani Mziray; Peter M Mbelele Journal: Int J Mycobacteriol Date: 2022 Jul-Sep
Authors: Riley H Hazard; Peninah Kagina; Richard Kitayimbwa; Keneth Male; Melissa McShane; Dennis Mubiru; Emma Welikhe; Christopher C Moore; Amir Abdallah Journal: Open Forum Infect Dis Date: 2019-03-14 Impact factor: 3.835
Authors: Maureen H Diaz; Jessica L Waller; M Jordan Theodore; Nishi Patel; Bernard J Wolff; Alvaro J Benitez; Timothy Morris; Pratima L Raghunathan; Robert F Breiman; Cynthia G Whitney; Dianna M Blau; Jonas M Winchell Journal: Clin Infect Dis Date: 2019-10-09 Impact factor: 9.079
Authors: Brenda A Kwambana-Adams; Jie Liu; Catherine Okoi; Jason M Mwenda; Nuredin I Mohammed; Enyonam Tsolenyanu; Lorna Awo Renner; Daniel Ansong; Beckie N Tagbo; Muhammad F Bashir; Mamadou Kourna Hama; Mouhamadou A Sonko; Jean Gratz; Archibald Worwui; Peter Ndow; Adam L Cohen; Fatima Serhan; Richard Mihigo; Martin Antonio; Eric Houpt Journal: Am J Trop Med Hyg Date: 2020-05-21 Impact factor: 2.345
Authors: Joseph N Paulson; Brent L Williams; Christine Hehnly; Nischay Mishra; Shamim A Sinnar; Lijun Zhang; Paddy Ssentongo; Edith Mbabazi-Kabachelor; Dona S S Wijetunge; Benjamin von Bredow; Ronnie Mulondo; Julius Kiwanuka; Francis Bajunirwe; Joel Bazira; Lisa M Bebell; Kathy Burgoine; Mara Couto-Rodriguez; Jessica E Ericson; Tim Erickson; Matthew Ferrari; Melissa Gladstone; Cheng Guo; Murali Haran; Mady Hornig; Albert M Isaacs; Brian Nsubuga Kaaya; Sheila M Kangere; Abhaya V Kulkarni; Elias Kumbakumba; Xiaoxiao Li; David D Limbrick; Joshua Magombe; Sarah U Morton; John Mugamba; James Ng; Peter Olupot-Olupot; Justin Onen; Mallory R Peterson; Farrah Roy; Kathryn Sheldon; Reid Townsend; Andrew D Weeks; Andrew J Whalen; John Quackenbush; Peter Ssenyonga; Michael Y Galperin; Mathieu Almeida; Hannah Atkins; Benjamin C Warf; W Ian Lipkin; James R Broach; Steven J Schiff Journal: Sci Transl Med Date: 2020-09-30 Impact factor: 17.956
Authors: Prakruti S Rao; Christopher C Moore; Amir A Mbonde; Edwin Nuwagira; Patrick Orikiriza; Dan Nyehangane; Mohammad H Al-Shaer; Charles A Peloquin; Jean Gratz; Suporn Pholwat; Rinah Arinaitwe; Yap Boum; Juliet Mwanga-Amumpaire; Eric R Houpt; Leonid Kagan; Scott K Heysell; Conrad Muzoora Journal: Antibiotics (Basel) Date: 2021-06-18