title: Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected children and infants in northern Tanzania.
abstract: OBJECTIVE
  To describe the contribution of paediatric HIV and of HIV co-infections to admissions to a hospital in Moshi, Tanzania, using contemporary laboratory methods.
  
  
  METHODS
  During 1 year, we enrolled consecutively admitted patients aged ≥2 months and <13 years with current or recent fever. All patients underwent standardized clinical history taking, a physical examination and HIV antibody testing; standard aerobic blood cultures and malaria film were also done, and hospital outcome was recorded. Early infant HIV diagnosis by HIV-1 RNA PCR was performed on those aged <18 months. HIV-infected patients also received serum cryptococcal antigen testing and had their CD4-positive T-lymphocyte count and percent determined.
  
  
  RESULTS
  A total of 467 patients were enrolled whose median age was 2 years (range 2 months-13 years); Of those patients, 57.2% were female and 12.2% were HIV-infected. Admission clinical diagnosis of HIV disease was made in 10.7% and of malaria in 60.4%. Of blood cultures, 5.8% grew pathogens; of these 25.9% were Salmonella enterica (including 6 Salmonella Typhi) and 22.2%Streptococcus pneumoniae. Plasmodium falciparum was identified on blood film of 1.3%. HIV infection was associated with S. pneumoniae (odds ratio 25.7, 95% CI 2.8, 234.0) bloodstream infection (BSI), but there was no evidence of an association with Escherichia coli or P. falciparum; Salmonella Typhi BSI occurred only among HIV-uninfected participants. The sensitivity and specificity of an admission clinical diagnosis of malaria were 100% and 40.3%; and for an admission diagnosis of bloodstream infection, they were 9.1% and 86.4%, respectively.
  
  
  CONCLUSIONS
  Streptococcus pneumoniae is a leading cause of bloodstream infection among paediatric admissions in Tanzania and is closely associated with HIV infection. Malaria was over-diagnosed clinically, whereas invasive bacterial disease was underestimated. HIV and HIV co-infections contribute to a substantial proportion of paediatric febrile admissions, underscoring the value of routine HIV testing.
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA. john.crump@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: Levina J
authors.initials: LJ
authors.lastname: Msuya
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 A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: John F
authors.initials: JF
authors.lastname: Shao
authors.forename: Werner
authors.initials: W
authors.lastname: Schimana
authors.forename: Coleen K
authors.initials: CK
authors.lastname: Cunningham
authors.forename: Grace D
authors.initials: GD
authors.lastname: Kinabo
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000382:microbiology; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis; D015497:HIV-1 / Q000302:isolation & purification; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data*; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D009181:Mycoses / Q000453:epidemiology* / Q000401:mortality; D010963:Plasmodium falciparum / Q000302:isolation & purification; D019779:Salmonella enterica / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D013636:Tanzania / Q000453:epidemiology