Archibald Lennox K, Kazembe Peter N, Nwanyanwu Okey, Mwansambo Charles, Reller L Barth, Jarvis William R
Regeneration Technologies, Inc., 11621 Research Circle, PO Box 2650, Alachua, FL 32616, USA.
J Infect Dis. 2003 Jul 15;188(2):202-8. doi: 10.1086/376507. Epub 2003 Jun 20.
The risk of Mycobacterium bovis bloodstream infection (BSI) in bacille Calmette-Guérin (BCG)-vaccinated children with human immunodeficiency virus (HIV) infection remains uncharacterized. We studied pediatric inpatients during the 1998 dry season in Malawi. After a detailed clinical evaluation, blood was drawn for culture and HIV testing. Of 229 children, 128 (56%) were male, 35 (15.3%) had BSI, and 30% of children aged >1.5 years (median, 2.7 years; range, 1 month-13 years) had HIV infection. The predominant pathogen was non-typhi Salmonella; neither Mycobacterium tuberculosis nor M. bovis was isolated. A diagnosis of malnutrition or sepsis was predictive of BSI; malnutrition alone correlated with both death and BSI. The bloodstream dissemination of M. tuberculosis and M. bovis BCG is uncommon in HIV-infected children vaccinated with BCG. Correlates such as malnutrition or sepsis can provide algorithms for identifying children who need observation or empirical antimicrobial therapy for BSI in the absence of appropriate laboratory testing.
接种卡介苗（BCG）的感染人类免疫缺陷病毒（HIV）的儿童发生牛分枝杆菌血流感染（BSI）的风险仍未明确。我们研究了1998年马拉维旱季期间的儿科住院患者。经过详细的临床评估后，采集血液进行培养和HIV检测。229名儿童中，128名（56%）为男性，35名（15.3%）发生BSI，年龄>1.5岁（中位数2.7岁；范围1个月至13岁）的儿童中有30%感染HIV。主要病原体是非伤寒沙门氏菌；未分离出结核分枝杆菌或牛分枝杆菌。营养不良或脓毒症的诊断可预测BSI；仅营养不良与死亡和BSI均相关。在接种BCG的HIV感染儿童中，结核分枝杆菌和卡介苗菌株的血流播散并不常见。营养不良或脓毒症等相关因素可为在缺乏适当实验室检测的情况下识别需要观察或接受BSI经验性抗菌治疗的儿童提供算法。
