Archibald L K, den Dulk M O, Pallangyo K J, Reller L B
Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA.
Clin Infect Dis. 1998 Feb;26(2):290-6. doi: 10.1086/516297.
Causes of community-acquired bloodstream infections (BSIs) in sub-Saharan Africa are unknown with regard to mycobacteria and fungi. We prospectively studied 517 consecutive febrile (axillary temperature, > or =37.5 degrees C) adults (> or =15 years of age) admitted to one hospital in Tanzania. After hospital admission and informed consent, blood was drawn for culture (of bacteria, mycobacteria, and fungi), determination of human immunodeficiency virus type 1 (HIV-1) status, and malaria smears. Malaria smears were prepared for a control group of 150 afebrile patients. One hundred and forty-five patients (28%) had BSI. Of these 145 patients, 118 (81%) were HIV-1-infected. HIV-positive patients were more likely than HIV-negative ones to have BSI (118 of 282 vs. 27 of 235; P < .0001). The three most frequently isolated pathogens were Mycobacterium tuberculosis (60 [39%]), non-typhi Salmonella species (29 [19%]), and Staphylococcus aureus (13 [8.3%]). The incidence of malaria parasitemia was similar in study and control patients (9.5% vs. 8%). In this patient population with high prevalence of HIV-1 infection, M. tuberculosis has become the foremost cause of documented BSI.
关于分枝杆菌和真菌，撒哈拉以南非洲社区获得性血流感染（BSIs）的病因尚不清楚。我们对坦桑尼亚一家医院连续收治的517名发热（腋温≥37.5摄氏度）成人（≥15岁）进行了前瞻性研究。入院并获得知情同意后，采集血液进行细菌、分枝杆菌和真菌培养，检测1型人类免疫缺陷病毒（HIV-1）状态，并进行疟疾涂片检查。为150名无发热患者的对照组制备了疟疾涂片。145名患者（28%）发生了血流感染。在这145名患者中，118名（81%）感染了HIV-1。HIV阳性患者比HIV阴性患者更易发生血流感染（282名中的118名 vs. 235名中的27名；P < .0001）。三种最常分离出的病原体是结核分枝杆菌（60例[39%]）、非伤寒沙门氏菌（29例[19%]）和金黄色葡萄球菌（13例[8.3%]）。研究患者和对照患者的疟疾寄生虫血症发生率相似（9.5% vs. 8%）。在这个HIV-1感染率很高的患者群体中，结核分枝杆菌已成为有记录的血流感染的首要病因。
