Etiologies of illness among patients meeting integrated management of adolescent and adult illness district clinician manual criteria for severe infections in northern Tanzania: implications for empiric antimicrobial therapy.
We describe the laboratory-confirmed etiologies of illness among participants in a hospital-based febrile illness cohort study in northern Tanzania who retrospectively met Integrated Management of Adolescent and Adult Illness District Clinician Manual (IMAI) criteria for septic shock, severe respiratory distress without shock, and severe pneumonia, and compare these etiologies against commonly used antimicrobials, including IMAI recommendations for emergency antibacterials (ceftriaxone or ampicillin plus gentamicin) and IMAI first-line recommendations for severe pneumonia (ceftriaxone and a macrolide). Among 423 participants hospitalized with febrile illness, there were 25 septic shock, 37 severe respiratory distress without shock, and 109 severe pneumonia cases. Ceftriaxone had the highest potential utility of all antimicrobials assessed, with responsive etiologies in 12 (48%) septic shock, 5 (14%) severe respiratory distress without shock, and 19 (17%) severe pneumonia illnesses. For each syndrome 17-27% of participants had etiologic diagnoses that would be non-responsive to ceftriaxone, but responsive to other available antimicrobial regimens including amphotericin for cryptococcosis and histoplasmosis; anti-tuberculosis therapy for bacteremic disseminated tuberculosis; or tetracycline therapy for rickettsioses and Q fever. We conclude that although empiric ceftriaxone is appropriate in our setting, etiologies not explicitly addressed in IMAI guidance for these syndromes, such as cryptococcosis, histoplasmosis, and tetracycline-responsive bacterial infections, were common.
Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina; Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, North Carolina; Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Matthew P
MP
Rubach
Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina; Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, North Carolina; Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Venance P
VP
Maro
Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina; Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, North Carolina; Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
John A
JA
Bartlett
Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina; Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania; Duke Global Health Institute, Duke University, Durham, North Carolina; Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand john.crump@duke.edu.
John A
JA
Crump
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000667:Ampicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003453:Cryptococcosis / Q000188:drug therapy / Q000453:epidemiology; D004630:Emergencies; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006660:Histoplasmosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology; D013752:Tetracycline / Q000627:therapeutic use; D055815:Young Adult
D000890:Anti-Infective Agents; D005839:Gentamicins; D018942:Macrolides; D002443:Ceftriaxone; D000667:Ampicillin; D000666:Amphotericin B; D013752:Tetracycline