除了......之外，多种病原体也会导致与人类免疫缺陷病毒相关的败血症：来自坦桑尼亚的一项前瞻性队列研究。

Multiple pathogens contribute to human immunodeficiency virus-related sepsis in addition to : A prospective cohort in Tanzania.

机构信息

Department of medical services, Kibong'oto Infectious Diseases Hospital, Siha; Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.

Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.

出版信息

Int J Mycobacteriol. 2022 Jul-Sep;11(3):241-248. doi: 10.4103/ijmy.ijmy_80_22.

DOI:10.4103/ijmy.ijmy_80_22

PMID:36260441

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9582297/

Abstract

BACKGROUND

Mortality from tuberculosis (TB) sepsis is common among patients living with human immunodeficiency virus (PLHIV). We aimed to detect M. tuberculosis (MTB) and additional sepsis etiologies, and mortality determinants in PLHIV.

METHODS

This prospective cohort study consented and followed-up PLHIV for 28 days in northern Tanzania. From May through December 2021, patients provided urine and sputum for TB testing in lateral-flow lipoarabinomannan (LF-LAM) and Xpert® MTB/RIF. Bacterial blood culture, cryptococcal antigen, malaria rapid diagnostic, C-reactive-protein (CRP), and international normalized ratio (INR) tests were also performed. Sepsis severity was clinically measured by Karnofsky and modified early warning signs (MEWS) scores. Anti-TB, broad-spectrum antibiotics, and antimalarial and antifungal agents were prescribed in accordance with Tanzania treatment guideline. An independent t-test and Chi-square or Fisher's exact tests compared means and proportions, respectively. P < 0.05 was statistically significant.

RESULTS

Among 98 patients, 59 (60.2%) were female. Their mean (standard deviation) age was 44 (12.9) years. TB detection increased from 24 (24.5%) by Xpert® MTB/RIF to 36 (36.7%) when LF-LAM was added. In total, 23 (23.5%) patients had other than TB etiologies of sepsis, including Staphylococcus aureus, Streptococcus pneumoniae, Cryptococcus spp., and Plasmodium spp. Twenty-four (94.4%) of 36 patients with TB had higher CRP (≥10 mg/l) compared to 25 (40.3%) non-TB patients (P < 0.001). Nine (9.2%) patients died and almost all had INR ≥1.8 (n = 8), Karnofsky score <50% (n = 9), MEWS score >6 (n = 8), and malnutrition (n = 9).

CONCLUSIONS

MTB and other microbes contributed to sepsis in PLHIV. Adding non-TB tests informed clinical decisions. Mortality was predicted by conventional sepsis and severity scoring, malnutrition, and elevated INR.

摘要

背景

结核病（TB）败血症导致的死亡率在人类免疫缺陷病毒（PLHIV）感染者中较为常见。我们旨在检测 PLHIV 中的结核分枝杆菌（MTB）和其他败血症病因，并确定死亡率的决定因素。

方法

这是一项在坦桑尼亚北部进行的前瞻性队列研究，对 PLHIV 进行了 28 天的随访。在 2021 年 5 月至 12 月期间，患者提供尿液和痰液进行侧流脂阿拉伯甘露聚糖（LF-LAM）和 Xpert® MTB/RIF 检测。还进行了细菌血培养、隐球菌抗原、疟疾快速诊断、C 反应蛋白（CRP）和国际标准化比值（INR）检测。败血症严重程度通过卡诺夫斯基和改良早期预警评分（MEWS）进行临床评估。根据坦桑尼亚治疗指南，开具抗结核药物、广谱抗生素、抗疟和抗真菌药物。采用独立 t 检验和卡方检验或 Fisher 确切检验分别比较均值和比例。P<0.05 为统计学显著差异。

结果

在 98 名患者中，59 名（60.2%）为女性。他们的平均（标准差）年龄为 44（12.9）岁。通过 Xpert® MTB/RIF 检测，结核病的检出率为 24（24.5%），当加入 LF-LAM 时，结核病的检出率增加至 36（36.7%）。总共有 23 名（23.5%）患者的败血症除了结核病病因之外还有其他病因，包括金黄色葡萄球菌、肺炎链球菌、隐球菌属和疟原虫属。36 名结核病患者中有 24 名（94.4%）CRP（≥10mg/l）高于 25 名非结核病患者（40.3%）（P<0.001）。9 名（9.2%）患者死亡，几乎所有患者的 INR≥1.8（n=8）、卡诺夫斯基评分<50%（n=9）、MEWS 评分>6（n=8）和营养不良（n=9）。