<i>Mycobacterium tuberculosis</i> complex bacteremia among HIV and non-HIV patients in a Mexican tertiary care center

Tamez-Torres, Karla Maria; Torres-Gonzalez, Pedro; Cervera-Hernandez, Miguel E.; Chavez-Mazari, Barbara; Barrientos-Flores, Corazon de Jesus; Bobadilla-del-Valle, Miriam; Ponce-de-Leon, Alfredo; Sifuentes-Osornio, Jose

doi:10.1016/j.bjid.2018.10.274

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Original articles • Braz J Infect Dis 22 (5) • Sep-Oct 2018 • https://doi.org/10.1016/j.bjid.2018.10.274 copy

Mycobacterium tuberculosis complex bacteremia among HIV and non-HIV patients in a Mexican tertiary care center

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

To determine the factors associated with Mycobacterium tuberculosis complex-positive blood culture.

Methods:

Case-control study. Sociodemographic, clinical and laboratory data were collected from 2000 to 2015.

Results:

We reviewed medical records of 533 patients with culture-proven tuberculosis, of whom 27.2% (145/533) had blood culture available. Patients with mycobacteremia presented more frequently with abdominal tuberculosis, body mass index <18 kg/m², and had lower hemoglobin and albumin levels. No differences were observed regarding HIV status.

Conclusions:

Few studies have reported on the characteristics associated with Mycobacterium tuberculosis complex bacteremia, especially among Human Immunodeficiency Virus-negative patients. Out of 145 tuberculosis-infected patients with blood culture results available, 21 turned out positive. Anemia, hypoalbuminemia, and a body mass index < 18 kg/m² were associated with mycobacteremia.

Keywords:
Mycobacterium tuberculosis; Human immunodeficiency virus; Bloodstream infection; Mycobacteremia; Case-control study

Characteristic	Positive blood culture (n = 21)	Negative blood culture (n = 124)	p ^a a p values were determined by the χ2 test.
Age, years, median (IQR)	34 (38-54)	36 (28-51)	0.92^b b p values were determined by the Mann-Whitney U test.
Sex (male)	15/21 (71.4)	83/124 (66.9)	0.68
Underweight	8/16 (50)	16/108 (14.8)	0.001
BGC vaccination	9/12 (75)	58/85 (68.2)	0.63
HIV coinfection	11/20 (55)	53/114 (46.4)	0.48
CD4 count ≤100 cells/mm ³	6/8 (75.0)	35/44 (79.5)	0.77
CD4 count mean (IQR)	60 (7-185.5)	37.5 (21-94.5)	0.939
Diagnosed within 90 days of TB	8/11 (72.7)	26/52 (50)	0.16
Diabetes mellitus	2/21 (9.5)	16/124 (12.9)	0.66
Connective tissue disease	3/21 (14.2)	14/124 (11.2)	0.69
Solid or Hematologic malignancy	1/21 (4.7)	6/124 (4.8)	0.988
Charlson comorbidity index, median (IQR)	5 (1-6)	3.5 (0-6)	0.685
Symptoms
Symptoms onset, days, median (IQR)	76 (37-118)	64 (29-131)	0.631
Fever	17/21 (80.9)	106/124 (85.4)	0.592
Weight loss	14/21 (14.5)	71/123 (57.7)	0.441
Night sweats	8/21 (38.1)	69/123 (56.1)	0.126
Respiratory symptoms	11/21 (54.3)	67/124 (54)	0.888
Gastrointestinal symptoms
Use of immunosuppressive drugs	4/21 (19.0)	21/124 (16.9)	0.81
Additional sites of MTBC isolation
Pulmonary	14/21 (66.6)	89/124 (71.7)	0.63
Abdominal^c c Ascites, gastrointestinal biopsies, intraabdominal lymph nodes, or fecal samples.	8/21 (38.1)	21/124 (16.9)	0.025
Central nervous system	2/21 (9.5)	18/124 (14.5)	0.54
Genitourinary	7/21 (33.3)	26/124 (20.9)	0.21
Skin, joint, bone, and soft tissue	0/21 (0)	3/124 (2.4)	>0.99^d d p values were determined by Fisher's exact test.
Lymph node	1/21 (4.7)	3/124 (2.4)	0.54
Bone marrow positive TB culture	3/6 (50)	3/25 (12)	0.034
Chest radiography pattern
Normal	3/19 (15.7)	16/112 (14.2)	0.86
Miliary	8/19 (42.1)	36/112 (32.1)	0.39
Cavitary	0/19 (0)	8/112 (7.1)	-
Other	8/19 (42.1)	55/112 (49.1)	0.33
Laboratory test results at diagnosis
Hemoglobin, median g/dL (IQR)	9 (7.5-9.7)	10.5 (9-12)	0.003^b b p values were determined by the Mann-Whitney U test.
Hemoglobin ≤10 g/dL	16/20 (80)	50/121 (41.3)	0.001
Leukocytes, median cells/µL (IQR)	6 (4-8.9)	7 (4.4-10.7)	0.45^b b p values were determined by the Mann-Whitney U test.
Platelets, median cells/µL (IQR)	173 (88-302)	290 (185-372)	0.077^b b p values were determined by the Mann-Whitney U test.
Albumin, median g/dL (IQR)	1.7 (1.4-2.4)	2.6 (1.9-3.1)	<0.001^b b p values were determined by the Mann-Whitney U test.
Albumin ≤2 g/dL	11/18 (61.1)	27/106 (25.4)	0.002
Mycobacterial species
Mycobacterium bovis	6/21 (28.5)	59/124 (47.5)	0.1
Mycobacterium tuberculosis	15/21 (71.4)	65/124 (52.4)
In-hospital TB related mortality	4/21 (19)	6/124 (4.8)	0.017

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[1] *Corresponding author. E-mail address: sifuentesosornio@gmail.com (J. Sifuentes-Osornio).