Mycobacterium tuberculosis bacteremia in HIV-negative patients.
OBJECTIVE
Limited information exists about the epidemiologic characteristics of HIV-negative patients with Mycobacterium tuberculosis bacteremia (MTB).


METHODS
We retrospectively surveyed tuberculosis (TB) cases reported at National Taiwan University Hospital between 1997 and 2003. Demographic data, underlying diseases or conditions, clinical, microbiologic and radiologic findings and therapy were collected. Long-term outcome was evaluated at 1 year after initiation of anti-TB agents.


RESULTS
During the study period the incidence of MTB bacteremia in HIV-negative patients and HIV-positive patients were 0.024 and 6.2 per 1000 discharges, respectively (p<0.01). All 11 HIV-negative patients were males and eight (73%) were more than 50 years old. The most common underlying diseases/conditions were immunosuppressive therapy (64%) and heart disease (55%). Fever (80%), lymphopenia (75%) and pulmonary symptoms (58%) were the most common presentations. Ten patients were septic, two had septic shock and two had acute respiratory distress syndrome on admission. The median interval between admission and initiation of therapy for those who were cured was 6 days. Six (55%) died of TB and/or their underlying diseases. Of the six patients who died, the median survival after collection of positive blood culture was 19 days for three treated patients and 7 days for three untreated patients (p=0.01).


CONCLUSIONS
This case series demonstrates the wide spectrum of the initial presentation of HIV-negative patients with MTB bacteremia. The case fatality rate was high and was likely due to immunocompromised status and no anti-TB treatment prior to death. A high index of suspicion for TB and blood culture for MTB provides an additional simple and noninvasive diagnostic method to detect disseminated TB in endemic areas.
Chiu
Yu-Shin
YS
Division of Infectious Disease, Min-Sheng General Hospital, Taoyuan, and Division of Infectious Disease, Department of Internal Medicine, Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
Wang
Jann-Tay
JT
Chang
Shan-Chwen
SC
Tang
Jih-Luh
JL
Ku
Shih-Chi
SC
Hung
Chien-Ching
CC
Hsueh
Po-Ren
PR
Chen
Yee-Chun
YC
D000995:Antitubercular Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology*; D005334:Fever; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008171:Lung Diseases / Q000175:diagnosis; D008231:Lymphopenia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*
D000995:Antitubercular Agents; D007166:Immunosuppressive Agents