title: Mycobacterium tuberculosis bacteremia in HIV-negative patients.
abstract: 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.
authors.affiliation: 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.
authors.forename: Yu-Shin
authors.initials: YS
authors.lastname: Chiu
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
authors.forename: Jih-Luh
authors.initials: JL
authors.lastname: Tang
authors.forename: Shih-Chi
authors.initials: SC
authors.lastname: Ku
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
mesh_terms: 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*
chemical_list: D000995:Antitubercular Agents; D007166:Immunosuppressive Agents