Introduction
Materials and methods
Setting
Study design and inclusion criteria
Clinical laboratory methods
Case definitions
Statistical methods
Results
Patient characteristics and main diagnoses
Total (n = 382) | HIV+ (n = 77) | HIV− (n = 305) |
p value | OR (95 % CI) | |
---|---|---|---|---|---|
Demographics | |||||
Age (years) | 34 (25–46) | 37 (31–45) | 33 (23–47) |
0.04
| |
Male sex | 142 (37.2) | 22 (28.6) | 120 (31.4) | 0.08 | 0.62 (0.36–1.06) |
Duration of complaints (days) | 3 (2–6) | 4 (1–11) | 3 (2–5) |
<0.0001
| |
Travel time (h) | 0.5 (0.3–1.0) | 0.5 (0.5–1.6) | 0.5 (0.3–1.0) |
0.005
| |
Diagnoses | |||||
Malaria | 130 (34.1) | 14 (18.2) | 116 (38.0) |
0.001
|
0.36 (0.19–0.68)
|
Malaria parasites/μLa
| 7200 (1560–24000) | 54000 (21990–127200) | 5040 (1425–18000) |
0.0003
| |
Sepsis | 107 (28.1)b
| 26 (33.8) | 81 (26.6) | 0.21 | 1.41 (0.82–2.41) |
Blood culture positive sepsis | 30 (7.9)b
| 12 (15.6) | 18 (5.9) |
0.005
|
2.95 (1.36–6.44)
|
Abdominal infectionb
| 41 (38.3) | 5 (19.2) | 36 (44.4) |
0.02
|
0.30 (0.10–0.87)
|
Pneumonia | 22 (20.6) | 9 (34.6) | 13 (16.0) |
0.02
|
3.45 (1.23–9.66)
|
Skin or soft tissue infection | 26 (24.3) | 8 (30.8) | 18 (22.2) | 0.38 | 1.56 (0.58–4.16) |
Urinary tract infection | 11 (10.3) | 4 (15.4) | 7 (8.6) | 0.32 | 1.92 (0.51–7.18) |
Primary bacteremia | 7 (6.5) | 0 (0.0) | 7 (8.6) | 0.19 | 0.17 (0.01–2.97)c
|
Tuberculosis | 29 (7.6)d
| 17 (22.1) | 12 (3.9) |
<0.0001
|
6.92 (3.14–15.24)
|
Pulmonary tuberculosis | 22 (75.9)d
| 13 (76.5) | 9 (75.0) | 0.92 | 1.08 (0.19–6.06) |
Ziehl–Neelsen or auramine confirmed | 13 (44.8) | 6 (35.3) | 7 (58.3) | 0.22 | 0.39 (0.09–1.78) |
HIV-positive patients (n = 77) |
p value | |
---|---|---|
HIV status known prior to admission | 35 (45.5) | – |
Patients with a history of cART | 21 (27.3) | – |
Patients on cART | 15 (19.5) | – |
CD4 count (n = 68) | 168 (61–438) | – |
CD4 count in patients on cART (n = 14) | 273 (41–578) | 0.33 |
CD4 count in patients with no previous cART (n = 50) | 168 (73–458) | |
CD4 count in patients who abandoned cART (n = 5) | 48 (39–231) | |
CD4 count in malaria cases (n = 13) | 377 (121–730) | 0.26 |
CD4 count in sepsis cases (n = 22) | 168 (95–398) | |
CD4 count in culture confirmed BSI cases (n = 12) | 150 (67–198) | |
CD4 count in tuberculosis cases (n = 16) | 97 (46–158) |
Total (n = 379) | HIV+ (n = 77) | HIV− (n = 302)a
|
p value | OR (95 % CI) | |
---|---|---|---|---|---|
Medication for current illnessb
| |||||
Total | 295 (77.8) | 56 (72.7) | 242 (80.1) | 0.1375 | 0.65 (0.36–1.15) |
Analgesics | 234 (79.4) | 35 (62.5) | 200 (82.3) |
0.0011
|
0.36 (0.19–0.68)
|
Antimalarials | 79 (26.7) | 11 (19.6) | 68 (28.0) | 0.2408 | 0.63 (0.31–1.29) |
Antibiotics | 57 (19.3) | 20 (35.7) | 37 (15.2) |
0.0004
|
3.1 (1.6–5.9)
|
Other | 19 (6.4) | 7 (12.5) | 12 (4.9) |
0.0365
|
2.75 (1.03–7.34)
|
Source of medicationc
| |||||
Pharmacy | 93 (32.7) | 14 (25.9) | 79 (33.9) | 0.1927 | 0.63 (0.32–1.25) |
Hospital | 84 (29.6) | 26 (46.4) | 58 (24.9) |
0.0005
|
2.88 (1.56–5.29)
|
Other hospital | 55 (19.4) | 18 (32.1) | 37 (15.9) |
0.0033
|
2.65 (1.36–5.16)
|
Study hospital | 29 (10.2) | 8 (14.3) | 21 (9.0) | 0.1644 | 1.85 (0.77–4.47) |
Dispensary | 36 (12.7) | 7 (12.5) | 28 (12.4) | 0.8482 | 1.09 (0.61–3.67) |
Traditional medicine | 5 (1.8) | 1 (1.8) | 3 (1.3) | 0.7462 | 1.46 (0.45–2.65) |
Various informal | 44 (15.5) | 2 (3.7) | 42 (18.0) |
0.0085
|
0.17 (0.04–0.75)
|
Bacterial bloodstream infections
Total (n = 40) | HIV+ (n = 15) | HIV− (n = 23) |
p value | OR (95 % CI) | |
---|---|---|---|---|---|
Escherichia coli
| 12 (30.0)a
| 3 (20.0) | 8 (34.8) | 0.33 | 0.47 (0.10–2.16) |
Staphylococcus aureus
| 6 (15.0)a
| 3 (20.0) | 2 (8.7) | 0.31 | 2.63 (0.38–18.00) |
Streptococcus pneumoniae
| 5 (12.5) | 5 (33.3) | 0 (0.0) |
0.003
|
24.62 (1.24–487.5)
b
|
Salmonella typhi
| 2 (5.0) | 0 (0.0) | 2 (8.7) | 0.24 | 0.28 (0.01–6.20)b
|
Non-typhoidal salmonellae | 2 (5.0) | 2 (13.3) | 0 (0.0) | 0.09 | 7.58 (0.34–169.0)b
|
Klebsiella pneumoniae
| 1 (2.5) | 0 (0.0) | 1 (4.3) | 0.41 | 0.48 (0.02–12.68)b
|
Serratia marcescens
| 1 (2.5) | 0 (0.0) | 1 (4.3) | 0.41 | 0.48 (0.02–12.68)b
|
Streptococcus viridans
| 1 (2.5) | 1 (6.7) | 0 (0.0) | 0.21 | 4.86 (0.19–127.6)b
|
Neisseria meningitidis
| 1 (2.5) | 0 (0.0) | 1 (4.3) | 0.41 | 0.48 (0.02–12.68)b
|
Bacteroides spp. | 1 (2.5) | 0 (0.0) | 1 (4.3) | 0.41 | 0.48 (0.02–12.68)b
|
B-Hemolytic streptococcic
| 8 (25.0) | 1 (8.3) | 7 (30.4) | 0.08 | 0.16 (0.02–1.50) |
Patient outcome
Total (n = 382) | HIV+ (n = 77) | HIV− (n = 305) |
p value | OR (95 % CI) | |
---|---|---|---|---|---|
Length of stay (days) | |||||
Total | 4 (2–6) | 5 (3–9) | 4 (3–5) |
<0.0001
| |
Malaria | 3 (3–4) | 4 (4–6) | 3 (3–4) |
0.001
| |
Sepsis | 5 (3–8) | 5 (3–10) | 5 (3–7) | 0.63 | |
Culture proven sepsis | 5 (3–9) | 8 (3–12) | 4 (3–7) | 0.10 | |
Tuberculosis | 13 (9–14) | 11 (5–15) | 13 (10–14) | 0.84 | |
In hospital mortality | |||||
Total | 16 (4.2) | 10 (13.0) | 6 (2.0) |
<0.0001
|
7.43 (2.61–21.18)
|
Malaria | 1 (0.8) | 1 (7.1) | 0 (0.0) |
0.005
|
24.10 (0.94–620.2)
a
|
Sepsis | 7 (6.5) | 4 (15.4) | 3 (3.7) |
0.04
|
4.73 (0.98–22.73)
|
Culture proven BSI | 5 (17.2) | 3 (25.0) | 2 (11.8) | 0.35 | 2.50 (0.35–17.95) |
Tuberculosis | 3 (11.1) | 3 (18.8) | 0 (0.0) | 0.13 | 5.96 (0.28–128.0)a
|