Bacteremia due to Mycobacterium tuberculosis or M. bovis, Bacille Calmette-Guerin (BCG) among HIV-positive children and adults in Zambia

Background: Among adults with advanced HIV infection in developing countrie s, bacteremia due to Mycobacterium tuberculosis (MTB) is common and bactere mia due to M. bovis (bacille Calmette-Guerin; BCC) is rare. Comparable data are not available for children with HIV. Objective: To compare the prevalence of bacteremia due to M. tuberculosis o r M. bovis BCG in hospitalized children and adults with HIV infection in a developing country with a high prevalence of tuberculosis and HIV and > 95% BCG immunization coverage. Design: Descriptive cross-sectional study. Methods: Prospectively hospitalized patients in Lusaka, Zambia who were sus pected to have HIV infection underwent phlebotomy for HIV ELISA, HIV viral load, and lysis-centrifugation blood culture for mycobacteria. Histories we re obtained and patients were examined for BCG scars. Mycobacterial isolate s were identified using DNA probes for MTB complex (MTBC), multiplex PCR an d IS6110 typing. Results: The median age of 387 HIV-positive children was 15 months; 98% wer e BCG immunized. The median age of 344 HIV-positive adults was 32 years; 44 % were BCG immunized. Blood cultures were positive for mycobacteria in six children (2%) and 38 adults(11%) (P < 0.001). The six pediatric isolates in cluded five MTBC (40% clustered) and one BCG. The 38 adult isolates include d 36 MTBC (16% clustered) and two M. avium complex. Conclusion: Bacteremia due to MTB is less common among children than adults with advanced HIV infection in Zambia. Bacteremia due to M. bovis BCG is r are even among children with recent BCG immunization and symptomatic HIV in fection. (C) 2001 Lippincott Williams & Wilkins.