title: Causes of fever in patients infected with human immunodeficiency virus who were admitted to Boston City Hospital.
abstract: We prospectively studied causes of fever in patients with human immunodeficiency virus (HIV) infection that required admission to a municipal hospital. A total of 168 HIV-infected persons were admitted for 220 episodes of fever: 72% were male, 80% were nonwhite, 65% reported prior injection drug use, and 74% had a baseline CD4 lymphocyte count of < 200/mm3. Bacterial infections, principally pneumonia, accounted for > 60% of the episodes; Streptococcus pneumoniae and Staphylococcus aureus were most commonly isolated. Pneumocystis carinii pneumonia (PCP) and disseminated infection with Mycobacterium avium complex (MAC) comprised 53% of the remaining sources of fever. In comparison with episodes of fever due to nonbacterial causes, those associated with common bacterial infections were significantly more likely to involve patients with a history of injection drug use (P = .02), higher admission leukocyte count (P < .004), shorter duration of fever (P = .003), shorter hospital stays (P = .0001), and a CD4 count of > 100/mm3 (P = .002). We conclude that bacterial infection, especially pneumonia, is a common cause of fever in HIV-infected patients admitted to our hospital. Patients with bacterial infections are more likely to report a history of injection drug use and have CD4 counts of > 100/mm3, shorter duration of fever, decreased length of hospitalization, and lower mortality than patients with fever due to PCP, disseminated MAC infection, or other causes.
authors.affiliation: Maxwell Finland Laboratory for Infectious Diseases, Section of Infectious Diseases, Boston City Hospital, Massachusetts, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Barat
authors.forename: J E
authors.initials: JE
authors.lastname: Gunn
authors.forename: K A
authors.initials: KA
authors.lastname: Steger
authors.forename: C J
authors.initials: CJ
authors.lastname: Perkins
authors.forename: D E
authors.initials: DE
authors.lastname: Craven
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies