肯尼亚内罗毕一群主要感染HIV-1的女性性工作者中的侵袭性肺炎球菌疾病。

Invasive pneumococcal disease in a cohort of predominantly HIV-1 infected female sex-workers in Nairobi, Kenya.

作者信息

Gilks C F, Ojoo S A, Ojoo J C, Brindle R J, Paul J, Batchelor B I, Kimari J N, Newnham R, Bwayo J, Plummer F A

机构信息

Chinical Research Centre, Kenya Medical Research Institute, Nairobi, Kenya.

出版信息

Lancet. 1996 Mar 16;347(9003):718-23. doi: 10.1016/s0140-6736(96)90076-8.

DOI:10.1016/s0140-6736(96)90076-8

PMID:8602001

Abstract

BACKGROUND

HIV infection is a major risk factor for pneumococcal disease in industrialised countries. Although both are common infections in sub-Saharan Africa, few studies have investigated the importance of this interaction. We have followed up a cohort of female sex-workers in Nairobi and report here on the extent of invasive pneumococcal disease.

METHODS

A well-established cohort of low-class female sex-workers, based around a community clinic, was followed up from October, 1989, to September, 1992. 587 participants were HIV positive and 132 remained HIV negative. Set protocols were used to investigate common presentations. Cases were identified clinically and radiographically. Streptococcus pneumoniae and other pathogens were diagnosed by culture.

FINDINGS

Seventy-nine episodes of invasive pneumococcal disease were seen in the 587 HIV-positive women compared with one episode in the 132 seronegative women (relative risk 17.8, 95% CI 2.5 to 126.5). In seropositive women the incidence rate was 42.5 per 1000 person-years and the recurrence rate was 264 per 1000 person-years. By serotyping, most recurrent events were re-infection. A wide spectrum of HIV-related pneumococcal disease was seen: only 56% of cases were pneumonia; sinusitis was seen in 30% of cases, and occult bacteraemia, a novel adult presentation, in 11%. Despite forty-two bacteraemic episodes, no deaths were attributable to Strep pneumoniae. At first presentation the mean CD4 cell count was 302/microL(SD 191) and was 171/microL (105) for recurrent episodes. During acute Strep pneumoniae infection the CD4 cell count was reversibly suppressed (mean fall in sixteen episodes, 105/microL [123]). The neutrophil response to acute infection was blunted and was correlated with CD4 count (r=0.50, 95% CI 0.29 to 0.66). Strep pneumoniae caused more disease, at an earlier stage of HIV immunosuppression, than Mycobacterium tuberculosis or non-typhi salmonellae.

INTERPRETATION

Our study highlights the importance of the pneumococcus as an early but readily treatable complication of HIV infection in sub-Saharan Africa.

摘要

背景

在工业化国家，HIV感染是肺炎球菌疾病的主要危险因素。虽然这两种感染在撒哈拉以南非洲都很常见，但很少有研究调查这种相互作用的重要性。我们对在内罗毕的一组女性性工作者进行了随访，并在此报告侵袭性肺炎球菌疾病的患病情况。

方法

以一家社区诊所为基础，对一群固定的低阶层女性性工作者进行随访，时间从1989年10月至1992年9月。587名参与者HIV呈阳性，132名仍为HIV阴性。采用既定方案调查常见症状。通过临床和影像学检查确定病例。通过培养诊断肺炎链球菌和其他病原体。

结果

在587名HIV阳性女性中出现了79例侵袭性肺炎球菌疾病，而在132名血清阴性女性中仅出现1例（相对危险度17.8，95%可信区间2.5至126.5）。在血清阳性女性中，发病率为每1000人年42.5例，复发率为每1000人年264例。通过血清分型，大多数复发事件为再次感染。观察到一系列与HIV相关的肺炎球菌疾病：仅56%的病例为肺炎；30%的病例为鼻窦炎，11%的病例为隐匿性菌血症，这是一种新的成人表现形式。尽管有42次菌血症发作，但没有死亡归因于肺炎链球菌。首次就诊时CD4细胞计数的平均值为302/μL（标准差191），复发时为171/μL（105）。在急性肺炎链球菌感染期间，CD4细胞计数被可逆性抑制（16次发作时平均下降105/μL[123]）。中性粒细胞对急性感染的反应减弱，且与CD4计数相关（r=0.50，95%可信区间0.29至0.66）。与结核分枝杆菌或非伤寒沙门菌相比，肺炎链球菌在HIV免疫抑制的早期阶段导致更多疾病。