A prospective study of community-acquired bloodstream infections among febrile adults admitted to Mulago Hospital in Kampala, Uganda

Francis N. Ssali, Moses R. Kamya, Fred Wabwire-Mangen, Simon Kasasa, Moses Joloba, Donna Williams, Roy D. Mugerwa, Jerrold J. Ellner, John L. Johnson

Research output: Contribution to journalArticlepeer-review

Abstract

Septicemia is a frequent cause of death in HIV-infected adults in developing countries. Additional prospective studies are needed to determine the etiology of bloodstream infections (BSI) in febrile HIV-infected adults and guide initial evaluation and treatment in this setting. We assessed the prevalence and etiology of community-acquired BSI among 299 consecutive febrile adult medical admissions to Mulago Hospital, Kampala, Uganda, over a 4-month period in 1997. The median age of our patients was 30 years, 159 (53%) were male, and 227 (76%) HIV-1-seropositive. Overall, prevalence of bacteremia or fungemia (1 patient) was 24%. Bacteremia was more frequent in HIV-infected than in uninfected patients (27% versus 15%, respectively; p = .04). Mycobacterium tuberculosis (n = 28), Streptococcus pneumoniae (n = 15) and Salmonella species (n = 13) were the most frequent isolates. All Salmonella and mycobacterial isolates were recovered from HIV-infected patients. Pneumococcal bacteremia was not associated with HIV seropositivity. M. avium complex and M. simiae were isolated from two HIV-infected patients. The rate of mycobacteremia among febrile HIV-infected adults presenting for hospitalization was 13%. Bacteremia and disseminated tuberculosis are frequent causes of morbidity in febrile HIV-infected Ugandan adults. Initial empiric antibiotic coverage in this setting should be targeted toward the pneumococcus and gram-negative enteric bacilli, especially nontyphi Salmonella species. All patients presenting with chronic cough should be evaluated for tuberculosis.

Original languageEnglish (US)
Pages (from-to)484-489
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes and Human Retrovirology
Volume19
Issue number5
StatePublished - Dec 15 1998
Externally publishedYes

Keywords

  • Bacteremia
  • Fever
  • HIV
  • Mycobacteremia
  • Mycobacterium avium complex
  • Mycobacterium simiae
  • Salmonella
  • Tuberculosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Virology

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