Fever and human immunodeficiency virus infection as sentinels for emerging mycobacterial and fungal bloodstream infections in hospitalized patients >/=15 years old, Bangkok.
To determine the etiology of bloodstream infections (BSIs) in hospitalized patients >/=15 years old in Thailand, prospectively enrolled, consecutive febrile (>/=38 degrees C) patients were admitted to one hospital during February-April 1997. After a patient history was taken and a physical examination was performed, blood was obtained for comprehensive culture and human immunodeficiency virus (HIV) testing. Of 246 study patients, 119 (48%) had BSIs, and 182 (74%) were infected with HIV. The 2 most common pathogens were Cryptococcus neoformans and Mycobacterium tuberculosis (30 and 27 patients, respectively). HIV-positive patients were more likely than HIV-negative patients to have mycobacteremia (57/182 vs. 0/64, P<. 0001), fungemia (38/182 vs. 2/64, P<.001), or polymicrobial BSIs (19/182 vs. 0/64, P<.002). Clinical predictors of BSIs included HIV infection, chronic diarrhea, lymphadenopathy, or splenomegaly. Mortality was higher among patients with than those without BSIs (P<. 001). Cohort-based microbiologic studies are critically important to diagnose emerging pathogens and to develop algorithms for empirical treatment of BSIs in developing countries.
Archibald
L K
LK
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. LCA6@cdc.gov
McDonald
L C
LC
Rheanpumikankit
S
S
Tansuphaswadikul
S
S
Chaovanich
A
A
Eampokalap
B
B
Banerjee
S N
SN
Reller
L B
LB
Jarvis
W R
WR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D003906:Developing Countries; D005260:Female; D005334:Fever / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D016469:Fungemia / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D013785:Thailand / Q000453:epidemiology