title: Bacteremic disseminated tuberculosis in sub-saharan Africa: a prospective cohort study.
abstract: BACKGROUND
  Disseminated tuberculosis is a major health problem in countries where generalized human immunodeficiency virus (HIV) infection epidemics coincide with high tuberculosis incidence rates; data are limited on patient outcomes beyond the inpatient period.
  
  
  METHODS
  We enrolled consecutive eligible febrile inpatients in Moshi, Tanzania, from 10 March 2006 through 28 August 2010; those with Mycobacterium tuberculosis bacteremia were followed up monthly for 12 months. Survival, predictors of bacteremic disseminated tuberculosis, and predictors of death were assessed. Antiretroviral therapy (ART) and tuberculosis treatment were provided.
  
  
  RESULTS
  A total of 508 participants were enrolled; 29 (5.7%) had M. tuberculosis isolated by blood culture. The median age of all study participants was 37.4 years (range, 13.6-104.8 years). Cough lasting >1 month (odds ratio [OR], 13.5; P< .001), fever lasting >1 month (OR, 7.8; P = .001), weight loss of >10% (OR, 10.0; P = .001), lymphadenopathy (OR 6.8; P = .002), HIV infection (OR, undefined; P < .001), and lower CD4 cell count and total lymphocyte count were associated with bacteremic disseminated tuberculosis. Fifty percent of participants with M. tuberculosis bacteremia died within 36 days of enrollment. Lower CD4 cell count (OR, 0.88; P = .049) and lower total lymphocyte count (OR, 0.76; P = .050) were associated with death. Magnitude of mycobacteremia tended to be higher among those with lower CD4 cell counts, but did not predict death.
  
  
  CONCLUSIONS
  In the era of free ART and access to tuberculosis treatment, almost one half of patients with M. tuberculosis bacteremia may die within a month of hospitalization. Simple clinical assessments can help to identify those with the condition. Advanced immunosuppression predicts death. Efforts should focus on early diagnosis and treatment of HIV infection, tuberculosis, and disseminated disease.
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC 27710, 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: 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: Boniface N
authors.initials: BN
authors.lastname: Njau
authors.forename: Godfrey S
authors.initials: GS
authors.lastname: Mushi
authors.forename: Venance P
authors.initials: VP
authors.lastname: Maro
authors.forename: L Barth
authors.initials: LB
authors.lastname: Reller
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000008:administration & dosage; D000995:Antitubercular Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011446:Prospective Studies; D016019:Survival Analysis; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents