Open AccessClinical indicators of mycobacteraemia in adults admitted to hospital in Blantyre
Author(s) -
DK Lewis,
Rph Peters,
M.J. Schijffelen,
G. Joaki,
Alissa Walsh,
James G. Kublin,
J Kumwenda,
Sam Kampondeni,
M.E. Molyneux,
EE Zijlstra
Publication year - 2004
Publication title -
malawi medical journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.43
H-Index - 18
eISSN - 1995-7270
pISSN - 1995-7262
DOI - 10.4314/mmj.v15i2.10778
Subject(s) - medicine , sputum , tuberculosis , disease , clinical trial , pediatrics , intensive care medicine , pathology
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.