Invasive bacterial and fungal infections among hospitalized HIV‐infected and HIV‐uninfected children and infants in northern Tanzania

Abstract

Summary OBJECTIVE To describe the contribution of paediatric HIV and of HIV co-infections to admissions to a hospital in Moshi, Tanzania, using contemporary laboratory methods. METHODS During 1 year, we enrolled consecutively admitted patients aged ≥2 months and <13 years with current or recent fever. All patients underwent standardized clinical history taking, a physical examination and HIV antibody testing; standard aerobic blood cultures and malaria film were also done, and hospital outcome was recorded. Early infant HIV diagnosis by HIV-1 RNA PCR was performed on those aged <18 months. HIV-infected patients also received serum cryptococcal antigen testing and had their CD4-positive T-lymphocyte count and percent determined. RESULTS A total of 467 patients were enrolled whose median age was 2 years (range 2 months–13 years); Of those patients, 57.2% were female and 12.2% were HIV-infected. Admission clinical diagnosis of HIV disease was made in 10.7% and of malaria in 60.4%. Of blood cultures, 5.8% grew pathogens; of these 25.9% were Salmonella enterica (including 6 Salmonella Typhi) and 22.2% Streptococcus pneumoniae. Plasmodium falciparum was identified on blood film of 1.3%. HIV infection was associated with S. pneumoniae (odds ratio 25.7, 95% CI 2.8, 234.0) bloodstream infection (BSI), but there was no evidence of an association with Escherichia coli or P. falciparum; Salmonella Typhi BSI occurred only among HIV-uninfected participants. The sensitivity and specificity of an admission clinical diagnosis of malaria were 100% and 40.3%; and for an admission diagnosis of bloodstream infection, they were 9.1% and 86.4%, respectively. CONCLUSION Streptococcus pneumoniae is a leading cause of bloodstream infection among paediatric admissions in Tanzania and is closely associated with HIV infection. Malaria was over-diagnosed clinically, whereas invasive bacterial disease was underestimated. HIV and HIV co-infections contribute to a substantial proportion of paediatric febrile admissions, underscoring the value of routine HIV testing.

Brucellosis among Hospitalized Febrile Patients in Northern Tanzania

“…Characteristics of the study population have been reported elsewhere. 25,26 Eight hundred thirty (95.4%) participants had at least one serum sample available for brucellosis testing. Four hundred fifty-five (52.3%) enrollees had both acute and convalescent (paired) sera tested for brucellosis.…”

Sensitivity and specificity of typhoid fever rapid antibody tests for laboratory diagnosis at two sub-Saharan African sites

“…The prevalence of HIV infection among participants in the study on febrile illness at KCMC and Mawenzi Regional Hospital was 39% for adolescents and adults and 12% for infants and children. 15,16 Although recent studies at KCMC have shown that HIV appears to protect against typhoid fever, disease may still occur in HIV-infected individuals. 15 It is possible that HIV-associated immune dysregulation affects the production of antibodies specific to Salmonella Typhi outer membrane proteins, present in both the Typhidot ® and the older Widal tests.…”

“…In South Africa, we enrolled subjects suspected of having typhoid fever; in the United Republic of Tanzania, we enrolled patients who were participants in a study on the etiology of febrile illness. 15,16 At both sites we incubated the blood in a continuously monitored blood culture system (Bac-T Alert, bioMérieux, Marcy L'Étoile, France). Bottles flagged as positive by the instrument were removed for subculture and identification by standard techniques.…”

Leptospirosis among Hospitalized Febrile Patients in Northern Tanzania

“…As part of a comprehensive study of the etiology of febrile illness in northern Tanzania, 5,6 we prospectively enrolled adult and pediatric inpatients at KCMC and MRH from 17 September 2007 through 31 August 2008. Adolescents and adults, defined as age ³ 13 years and admitted to the adult medicine ward, were eligible to participate if they had an oral temperature of ³ 38.0ºC.…”