title: Clinical indicators of mycobacteraemia in adults admitted to hospital in Blantyre.
abstract: The aims of the study were to measure the prevalence and outcome of mycobacteraemia in febrile hospitalised adults; to determine what proportion could be identified using routine methods; to assess clinical indicators of mycobacteraemia and the usefulness of a diagnostic trial of anti-TB treatment. We prospectively examined adults with fever or a history of fever admitted to adult medical wards of QECH, Blantyre. All had blood cultured for bacteria and mycobacteria, chest x-ray and sputum smears. M. tuberculosis was the commonest blood isolate, affecting 57 of 344 patients (17%). In 44 (77%) patients with mycobacteraemia, TB was identified using routine investigations; in only 6 (11%) it was not suspected. Strong clinical indicators of mycobacteraemia were anaemia, HIV seropositivity, cough, chronic fever, and a clinical diagnosis of AIDS on the day of admission. Of nine patients selected for a therapeutic trial of TB treatment, six had mycobacteraemia, of whom five died during the trial. Mortality on short course chemotherapy on the TB ward after one month, was similar whether patients had mycobacteramia (21%) or not (32%). TB can be identified with routine methods in most patients with mycobacteraemia. If treated, mycobacteraemia has as good an early outcome as TB without mycobacteraemia. Strengthening of basic facilities is likely to improve detection and treatment of mycobacterial disease.
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Blantyre.
authors.forename: D K
authors.initials: DK
authors.lastname: Lewis
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Blantyre.
authors.forename: Rph
authors.initials: R
authors.lastname: Peters
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Blantyre.
authors.forename: M J
authors.initials: MJ
authors.lastname: Schijffelen
authors.affiliation: Department of Microbiology, University of Malawi College of Medicine, Blantyre.
authors.forename: Grf
authors.initials: G
authors.lastname: Joaki
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre.
authors.forename: A L
authors.initials: AL
authors.lastname: Walsh
authors.affiliation: Department of Community Health, University of Malawi College of Medicine, Blantyre.
authors.forename: J G
authors.initials: JG
authors.lastname: Kublin
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Blantyre.
authors.forename: J
authors.initials: J
authors.lastname: Kumwenda
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Blantyre.
authors.forename: S
authors.initials: S
authors.lastname: Kampondeni
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Blantyre; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre.
authors.forename: M E
authors.initials: ME
authors.lastname: Molyneux
authors.affiliation: Department of Medicine, University of Malawi College of Medicine, Blantyre.
authors.forename: E E
authors.initials: EE
authors.lastname: Zijlstra