Rhodococcus equi and HIV-1 infection in Uganda

Objectives: To describe three cases of Rhodococcus equi infection in a coho rt of HIV-1 infected adults in Entebbe, Uganda and to compare this to the r ates and presentation of tuberculosis in this cohort. Methods: Consecutive HIV-1 infected adults registering with a community HIV /AIDS clinic in Entebbe were enrolled in a cohere between October 1995 and June 1998 as part of an intervention trial of pneumococcal polysaccharide v accine. Participants were routinely reviewed every 6 months and had open ac cess to the clinic when unwell. Standard protocols were followed for invest igation and management of illness. Microbiological investigations followed standard procedures. Results: 1372 (71% female) study participants were followed for 2141 person years of observation (pyo), Rhodococcus equi was isolated from three study participants from blood, a lymph node aspirate and stool. The individuals were undergoing investigation of acute pneumonia, acute cough With cervical lymphadenopathy and chronic fever with wasting, respectively The clinical features of these cases are described. All had a CD4 T-cell count of < 300/ <mu>l. The rate of R, equi infection in the cohort was 1.4/1000 pyo, There were 132 cases of pulmonary and extrapulmonary tuberculosis in the cohort w hich were diagnosed either microbiologically or clinically. The rate of lab oratory confirmed mycobacterial disease was 50.1/1000 pyo. The ratio of myc obacterial disease to R. equi disease was 36:1 (95% CI 11-113:1). Conclusions: Rhodococcus equi infection occurs in HIV-1 infected adults in Africa. The infection is clinically indistinguishable from pulmonary and ex tra-pulmonary tuberculosis in the cohort described here. Although the rate of R, equi disease is much less than that of tuberculosis, it is important to consider it in the differential diagnosis of tuberculous infection in ca ses which are smear negative. Rhodococcus equi infection is probably underd iagnosed in Africa due to a lack of microbiological facilities and its rese mblance to common commensal organisms. (C) 2000 The British Infection Socie ty.