title: High prevalence of Mycobacterium tuberculosis bacteraemia among a cohort of HIV-infected patients with severe sepsis in Lusaka, Zambia.
abstract: Tuberculosis is recognised as one of the leading causes of severe sepsis among HIV-infected patients. Most patients with Mycobacterium tuberculosis bacteraemia have advanced HIV disease with CD4 counts less than 100 cells/μl and its presentation is non-specific in most instances. This was a cross-sectional study which was done by analyzing data from 201 adult HIV-infected patients who met the inclusion criteria for severe sepsis. The prevalence of Mycobacterium tuberculosis bactraemia in the study population was 34.8%. Severe sepsis caused by other etiologies was observed in 33 (16.4%) of the participants. Concomitant infection of Mycobacterium tuberculosis bactraemia with other organisms is not uncommon in patients with severe sepsis. This cohort of HIV-infected patients had severe immunosuppression with a median CD4 count of 51 (20-136) cells/μl with moderate anaemia, mean haemoglobin 8.0 (3.0) g/dl, and were generally underweight with a mean mid upper arm circumference (MUAC) of 21.0 (3.4) cm. Mycobacterium tuberculosis bacteraemia is very common in HIV-infected patients with advanced HIV disease who present with severe sepsis. Mycobacterium tuberculosis bacteraemia co-infection with aerobic organisms is not uncommon. Factors that were independently associated with Mycobacterium tuberculosis bacteraemia in our study population were MUAC and sodium level.
authors.affiliation: 1 Maina Soko Military Hospital, Zambia.
authors.forename: Levy
authors.initials: L
authors.lastname: Muchemwa
authors.affiliation: 2 University Teaching Hospital, Zambia.
authors.forename: Lakhi
authors.initials: L
authors.lastname: Shabir
authors.affiliation: 3 Vanderbiit University, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Andrews
authors.affiliation: 4 University of Zambia, Zambia.
authors.forename: Mwango
authors.initials: M
authors.lastname: Bwalya
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015995:Prevalence; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology*; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
keywords: AIDS; highly active antiretroviral therapy; human immunodeficiency virus