Abstract
A prospective study of 403 febrile hospitalized Tanzania adults and adolescents demonstrated the important role of invasive bacterial and fungal infections and over-diagnosis of malaria. While associated with disseminated tuberculosis and cryptococcal disease, HIV appeared to protect against typhoid fever.
(See the editorial commentary by Levine and Farag, on pages
349-351
.)
Background
. Few studies describe patterns of human immunodeficiency virus (HIV) co-infections in African hospitals in the antiretroviral therapy (ART) era.
Methods
. We enrolled consecutive admitted patients aged ≥13 years with oral temperature of ≥38.0°C during 1 year in Moshi, Tanzania. A standardized clinical history and physical examination was done and hospital outcome recorded. HIV antibody testing, aerobic and mycobacterial blood cultures, and malaria film were performed. HIV-infected patients also received serum cryptococcal antigen testing and CD4
+
T lymphocyte count (CD4 cell count).
Results
. Of 403 patients enrolled, the median age was 38 years (range, 14–96 years), 217 (53.8%) were female, and 157 (39.0%) were HIV-infected. Of HIV-infected patients, the median CD4 cell count was 98 cells/μL (range, 1–1,105 cells/ μL), 20 (12.7%) were receiving ART, and 29 (18.5%) were receiving trimethoprim-sulfamethoxazole prophylaxis. There were 112 (27.7%) patients who had evidence of invasive disease, including 26 (23.2%) with
Salmonella
serotype Typhi infection, 24 (21.4%) with
Streptococcus pneumoniae
infection, 17 (15.2%) with
Cryptococcus neoformans
infection, 12 (10.7%) with
Mycobacterium tuberculosis
complex infection, 8 (7.1%) with
Plasmodium falciparum
infection, and 7 (6.3%) with
Escherichia coli
infection. HIV infection was associated with
M. tuberculosis
and
C. neoformans
bloodstream infection but not with
E. coli, S. pneumoniae,
or
P. falciparum
infection. HIV infection appeared to be protective against
Salmonella
. Typhi bloodstream infection (odds ratio, .12;
P
= .001).
Conclusions
. While
Salmonella
Typhi and
S. pneumoniae
were the most common causes of invasive infection overall,
M. tuberculosis
and
C. neoformans
were the leading causes of bloodstream infection among HIV-infected inpatients in Tanzania in the ART era. We demonstrate a protective effect of HIV against
Salmonella.
Typhi bloodstream infection in this setting. HIV co-infections continue to account for a large proportion of febrile admissions in Tanzania.