FATAL MYCOBACTERIUM-TUBERCULOSIS BLOOD-STREAM INFECTIONS IN FEBRILE HOSPITALIZED ADULTS IN DAR-ES-SALAAM, TANZANIA

Causes of community-acquired bloodstream infections (BSIs) in sub-Saha ran Africa are unknown with regard to mycobacteria and fungi. We prosp ectively studied 517 consecutive febrile (axillary temperature, greate r than or equal to 37.5 degrees C) adults (greater than or equal to 15 years of age) admitted to one hospital in Tanzania. After hospital ad mission and informed consent, blood was drawn for culture (of bacteria , mycobacteria, and fungi), determination of human immunodeficiency vi rus type 1 (HIV-1) status, and malaria smears. Malaria smears were pre pared for a control group of 150 afebrile patients. One hundred and fo rty-five patients (28%) had BSI. Of these 145 patients, 118 (81%) were HIV-1-infected. HIV-positive patients were more likely than HIV-negat ive 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 au reus (13 [8.3%]). The incidence of malaria parasitemia was similar in study and control patients (9.5% vs, 8%). In this patient population w ith high prevalence of HIV-1 infection, M. tuberculosis has become the foremost cause of documented BSI.