Prevalence of Mycobacteremia Among HIV-infected Infants and Children in Northern Tanzania

Abstract

Mycobacterium tuberculosis is a common cause of bloodstream infections among HIV-infected adults in sub-Saharan Africa, and is associated with high morbidity and mortality. We found no cases of mycobacteremia among 93 ill, HIV-infected children in northern Tanzania, despite optimization of laboratory methods and selection of patients thought to be at highest risk for disseminated infection.

Tuberculosis in Children

“…Mycobacterial blood cultures seem to be of limited yield in children compared to adults. 64,79–81 Histopathologic diagnosis is more commonly pursued in extra-pulmonary TB. The overall yield is not well characterized, and is somewhat dependent upon the experience of the proceduralist and pathologist; sensitivity and specificity may be hindered by other granulomatous processes.…”

<I>Mycobacterium tuberculosis</I> bacteremia in adults and children: a systematic review and meta-analysis

“…6, 7, 8 However in children, including those with HIV, MTB bacteremia is rarely reported. 9, 10, 11 Recency of Bacille de Calmette et Guérin (BCG) vaccine, limited available blood quantity for culture, degree of immunosuppression, quantity of blood drawn for MTB culture, and stage of TB disease (re-activation vs. primary infection) are hypothesized reasons for the discrepancy in the likelihood of detecting MTB bacteremia between adult and pediatric populations. 9, 11 We conducted a systematic review and meta-analysis to compare the prevalence of MTB bacteremia in adult and pediatric patient populations and used meta-regression to explore sources of heterogeneity in pooled prevalence estimates between these two populations.…”

Mycobacterium tuberculosis Bacteremia Among Acutely Febrile Children in Western Kenya

“…9,10 The lack of M. tuberculosis bacteremia identified in children observed in this study is consistent with previous pediatric studies, which have demonstrated the absence or extremely low prevalence of M. tuberculosis bacteremia in children. [13][14][15] Although our study included relatively few children with HIV, a known risk factor for disseminated TB, a recent study in Tanzania also reported no evidence of M. tuberculosis bacteremia among 93 HIVinfected infants and children with frequent severe immunosuppression (over 60%) and presenting with severe illness; however, only 25% had fever. 13 Although young age is a risk factor for the most severe forms of TB, including disseminated TB, available evidence suggests that M. tuberculosis bacteremia is uncommon among young children.…”

“…[13][14][15] Although our study included relatively few children with HIV, a known risk factor for disseminated TB, a recent study in Tanzania also reported no evidence of M. tuberculosis bacteremia among 93 HIVinfected infants and children with frequent severe immunosuppression (over 60%) and presenting with severe illness; however, only 25% had fever. 13 Although young age is a risk factor for the most severe forms of TB, including disseminated TB, available evidence suggests that M. tuberculosis bacteremia is uncommon among young children. 4,22 For bacterial bloodstream infections, blood volume and number of samples correlate with yield.…”

“…However, studies assessing M. tuberculosis bacteremia in children are limited and the prevalence of M. tuberculosis bacteremia in children with acute febrile illness has not been described. [13][14][15] Given the difficulty in establishing the diagnosis of M. tuberculosis bacteremia in many settings and the need for prompt initiation of anti-tuberculosis therapy to reduce mortality, we sought to determine the frequency and correlates of M. tuberculosis bacteremia in Kenyan children aged 6 months to 5 years presenting with fever to one of three western Kenya hospitals.…”