Utility of blood cultures and incidence of mycobacteremia in patients with suspected tuberculosis in a South African infectious disease referral hospital.
METHODS
A 500-bed government referral institution for patients with tuberculosis and other infectious diseases in Gauteng, South Africa.


OBJECTIVE
To assess the usefulness of BACTEC blood cultures over and above that of other microbiological methods for the diagnosis of tuberculosis in patients who are suspected of suffering from tuberculosis.


METHODS
Mycobacterial blood cultures were obtained from patients presenting with symptoms suspicious of tuberculosis and where there was no clinical evidence of other infectious etiologies, and from patients who had failed tuberculosis treatment.


RESULTS
Sixteen (22%) of 71 patients included in the study were positive for Mycobacterium tuberculosis on blood culture, while seven (10%) were positive for M. avium complex (MAC). Twelve (75%) of the patients with tuberculosis and positive blood cultures were however also positive for acid-fast bacilli on sputum smears and eight (50%) were initially diagnosed clinically and radiographically as localized pulmonary tuberculosis. Blood cultures positive for mycobacteria were only found among patients with human immunodeficiency virus infection (HIV).


CONCLUSIONS
Bacteremia with M. tuberculosis complex was detected in HIV-infected patients with suspected tuberculosis, even in patients presenting with localized pulmonary infection on initial clinical assessment. Among patients with suspected tuberculosis, blood cultures were useful in diagnosing unsuspected MAC disease, but did not add to the diagnostic yield of conventional tests for tuberculosis used routinely, namely sputum microscopy and culture, or occasional biopsy specimens.
Department of Clinical Microbiology and Infectious Diseases, University of Witwatersrand and the South African Institute for Medical Research, Johannesburg. avg@chiron.wits.ac.za
A
A
von Gottberg
L
L
Sacks
S
S
Machala
L
L
Blumberg
D017088:AIDS-Related Opportunistic Infections / Q000097:blood; D000328:Adult; D016470:Bacteremia / Q000175:diagnosis* / Q000453:epidemiology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015270:Mycobacterium avium-intracellulare Infection / Q000097:blood*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D013019:South Africa / Q000453:epidemiology; D018709:Statistics, Nonparametric; D014397:Tuberculosis, Pulmonary / Q000097:blood