Clinical indicators of mycobacteraemia in adults admitted to hospital in Blantyre, Malawi.
METHODS
Adult medical wards of a central hospital in Blantyre, Malawi.


OBJECTIVE
To measure the prevalence and outcome of mycobacteraemia in febrile hospitalised adults, and to determine what proportion could be identified using routine methods; to assess clinical indicators of mycobacteraemia, and the usefulness of a diagnostic trial of anti-tuberculosis treatment.


METHODS
We prospectively examined adults admitted with fever or a history of fever. All had blood cultured for bacteria and mycobacteria, chest X-ray and sputum smears.


RESULTS
Mycobacterium tuberculosis was the commonest cause of blood stream infection (BSI), affecting 57 of 344 patients (17%). In 44 (77%) patients with mycobacteraemia, TB was identified using routine investigations; it was not suspected in six (11%). Strong clinical indicators of mycobacteraemia were anaemia, HIV seropositivity, cough, chronic fever and a clinical diagnosis of AIDS on the day of admission. Of nine patients selected for a therapeutic trial of tuberculosis (TB) treatment, six had mycobacteraemia, of whom five died during the trial. Mortality on short-course chemotherapy, on the TB ward after 1 month was similar whether patients had mycobacteremia (21%) or not (32%).


CONCLUSIONS
TB can be identified with routine methods in most patients with mycobacteraemia. If treated, mycobacteraemia has as good an early outcome as TB without mycobacteraemia. Strengthening of basic facilities is likely to improve detection and treatment of mycobacterial disease.
Lewis
D K
DK
Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi. mariadavid@callaghanlewis.fsnet.co.uk
Peters
R P H
RP
Schijffelen
M J
MJ
Joaki
G R F
GR
Walsh
A L
AL
Kublin
J G
JG
Kumwenda
J
J
Kampondeni
S
S
Molyneux
M E
ME
Zijlstra
E E
EE
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D003955:Diagnostic Tests, Routine; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors
D000995:Antitubercular Agents