title: Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected adults and adolescents in northern Tanzania.
abstract: BACKGROUND
  few studies describe patterns of human immunodeficiency virus (HIV) co-infections in African hospitals in the antiretroviral therapy (ART) era.
  
  
  METHODS
  we enrolled consecutive admitted patients aged ≥ 13 years with oral temperature of ≥ 38.0°C during 1 year in Moshi, Tanzania. A standardized clinical history and physical examination was done and hospital outcome recorded. HIV antibody testing, aerobic and mycobacterial blood cultures, and malaria film were performed. HIV-infected patients also received serum cryptococcal antigen testing and CD4(+) T lymphocyte count (CD4 cell count).
  
  
  RESULTS
  of 403 patients enrolled, the median age was 38 years (range, 14-96 years), 217 (53.8%) were female, and 157 (39.0%) were HIV-infected. Of HIV-infected patients, the median CD4 cell count was 98 cells/μL (range, 1-1,105 cells/ μL), 20 (12.7%) were receiving ART, and 29 (18.5%) were receiving trimethoprim-sulfamethoxazole prophylaxis. There were 112 (27.7%) patients who had evidence of invasive disease, including 26 (23.2%) with Salmonella serotype Typhi infection, 24 (21.4%) with Streptococcus pneumoniae infection, 17 (15.2%) with Cryptococcus neoformans infection, 12 (10.7%) with Mycobacterium tuberculosis complex infection, 8 (7.1%) with Plasmodium falciparum infection, and 7 (6.3%) with Escherichia coli infection. HIV infection was associated with M. tuberculosis and C. neoformans bloodstream infection but not with E. coli, S. pneumoniae, or P. falciparum infection. HIV infection appeared to be protective against Salmonella. Typhi bloodstream infection (odds ratio, .12; P = .001).
  
  
  CONCLUSIONS
  while Salmonella Typhi and S. pneumoniae were the most common causes of invasive infection overall, M. tuberculosis and C. neoformans were the leading causes of bloodstream infection among HIV-infected inpatients in Tanzania in the ART era. We demonstrate a protective effect of HIV against Salmonella. Typhi bloodstream infection in this setting. HIV co-infections continue to account for a large proportion of febrile admissions in Tanzania.
authors.affiliation: Division of Infectious Diseases and International Health, Department ofMedicine, Duke University Medical Center, Box 102359, Durham, NC 27710, USA. crump017@mc.duke.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.forename: Habib O
authors.initials: HO
authors.lastname: Ramadhani
authors.forename: Anne B
authors.initials: AB
authors.lastname: Morrissey
authors.forename: Wilbrod
authors.initials: W
authors.lastname: Saganda
authors.forename: Mtumwa S
authors.initials: MS
authors.lastname: Mwako
authors.forename: Lan-Yan
authors.initials: LY
authors.lastname: Yang
authors.forename: Shein-Chung
authors.initials: SC
authors.lastname: Chow
authors.forename: Susan C
authors.initials: SC
authors.lastname: Morpeth
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
authors.forename: Boniface N
authors.initials: BN
authors.lastname: Njau
authors.forename: Andrea V
authors.initials: AV
authors.lastname: Shaw
authors.forename: Helmut C
authors.initials: HC
authors.lastname: Diefenthal
authors.forename: John F
authors.initials: JF
authors.lastname: Shao
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: Venance P
authors.initials: VP
authors.lastname: Maro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D005658:Fungi / Q000302:isolation & purification*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology*; D015995:Prevalence; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents