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Utility of Centrifugation Lysis Blood Cultures in the Diagnosis of Mycobacteria Tuberculosis in HIV Patients: Association With CD4 Counts <50 cells/mm3 FREE TO VIEW

M. Desruisseaux, MD; Andreas Kyprianou, MD; M. H. Kaplan, MD; A. M. Fein, MD; X. Arunabh, MD
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North Shore University Hospital, Manhasset, NY


Chest


Chest. 2003;124(4_MeetingAbstracts):114S. doi:10.1378/chest.124.4_MeetingAbstracts.114S-b
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Abstract

PURPOSE:  Tuberculosis is a frequent complication in human immunodeficiency virus [HIV] patients. We studied the clinical characteristics, therapy, and outcome of patients with Mycobacterium tuberculosis (MTB) bacteremia.

METHODS:  From 1984–2002, 60/3675 HIV patients were diagnosed with active MTB. Demographics data and cultures for MTB were noted; including all lysis-centrifugation blood cultures (LC-BC). Mycobacterial isolates and subspecies were identified from blood cultures (BC) using the Genprobe Isolation system.

RESULTS:  Mean age was 39 years [46 males; 14 females]. LC-BCs were positive for MTB in 11 patients. ( 18.3%). Bacteremic MTB patients had lower CD4 (mean CD4 56.2 cells/mm3 [range 1–330]) compared to nonbacteremic MTB patients [152 cells/mm3; range 52–762]) p<0.05(Mann-Whitney test)]. 9/24 patients with CD4 <50 cells/mm3 had a positive BC for MTB in contrast to 2/36 patients with a CD4 >50cells/mm3. There was no association between positive BC and any of the demographic/risk factors for HIV transmission. Four patients had concomitant other mycobacterial infections [3 MAI diagnosed in sputum and one with M kansasaii concomitantly in blood]. MTB was isolated from sputum in 10/11 bacteremic patients. Concomitant bacteremia with nonmycobacterial organisms was noted in patients with CD 4 < 50 [11/ 24 vs 7/ 36 in patients with CD4>50]. 3/11 bacteremic patients died in contrast to 5/36 nonbacteremic patients.CONCLUSIONS: MTB bacteremia is common among adults with advanced HIV infection occurring at an advanced stage of HIV when the CD 4 cell counts are <50 cells/mm 3. LC-BC is particularly helpful in making a diagnosis of MTB in HIV patients with low CD4 counts especially when cultures from other sites remain negative. LC-BC growing MTB indicate more severe and disseminated MTB and provides an extremely useful source of MTB for drug sensitivity testing for appropriate management of MTB in HIV.

CLINICAL IMPLICATIONS:  In severely immunosuppressed patients multiple LC-BC are required for the diagnosis of MTB, for drug sensitivity testing, and to establish the diagnosis of other mycobacterial coinfections.

DISCLOSURE:  M. Desruisseaux, None.

Tuesday, October 28, 2003

2:30 PM - 4:00 PM


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