Malaria is an uncommon cause of adult sepsis in south-western Uganda.
Malaria is an uncommon cause of adult sepsis in south-western Uganda.
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DOI：
10.1186/1475-2875-12-146
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发表时间：
2013-05-01
期刊：
影响因子：
3
通讯作者：
Moore CC
中科院分区：
文献类型：
--
作者：
Auma MA;Siedner MJ;Nyehangane D;Nalusaji A;Nakaye M;Mwanga-Amumpaire J;Muhindo R;Wilson LA;Boum Y 2nd;Moore CC
疟疾通常被认为是疟疾流行地区成人败血症的原因。然而，诊断的局限性使得区分疟疾和其他感染具有挑战性。因此，本研究的目的是确定疟疾对乌干达西南部成人败血症的相对贡献。2012年2月至5月期间，在姆巴拉拉地区转诊医院招募了脓毒症成人患者。脓毒症定义为感染加上以下情况中的≥2项：腋温>37.5 ℃或<35.5 ℃，心率>90或呼吸频率>20。严重脓毒症定义为脓毒症加器官功能障碍（血乳酸>4 mmol/L、意识模糊或收缩压<90 mmHg）。收集了社会人口、临床和实验室数据，包括疟疾PCR和快速诊断测试，以及抗酸菌痰涂片和血培养。对患者进行随访，直至患者住院死亡或出院。关注的主要结局是脓毒症的原因。进行多变量logistic回归以评估死亡率的预测因素。入组了216名参与者，其中51%为女性，中位年龄为32岁（IQR 27-43岁）。其中，122例（56%）受试者为HIV血清阳性，其中75例（66%）CD 4 + T细胞计数<100个细胞/μL。疟疾流行率为4%（6例为恶性疟原虫，2例为间日疟原虫）。在41例（19%）患者中发现了菌血症。住院死亡率为19%（n = 42）。在多变量回归分析中，格拉斯哥昏迷评分<9（IRR 4.81，95% CI 1.80-12.8）和严重脓毒症（IRR，2.07，95% CI 1.03-4.14）与住院死亡率有统计学相关性，但无具体诊断。在乌干达西南部的一家地区转诊医院，疟疾是成人败血症的一种罕见原因。在这种情况下，建议对脓毒症患者的其他病因进行全面评估。
Malaria is often considered a cause of adult sepsis in malaria endemic areas. However, diagnostic limitations can make distinction between malaria and other infections challenging. Therefore, the objective of this study was to determine the relative contribution of malaria to adult sepsis in south-western Uganda. Adult patients with sepsis were enrolled at the Mbarara Regional Referral Hospital between February and May 2012. Sepsis was defined as infection plus ≥2 of the following: axillary temperature >37.5°C or <35.5°C, heart rate >90 or respiratory rate >20. Severe sepsis was defined as sepsis plus organ dysfunction (blood lactate >4 mmol/L, confusion, or a systolic blood pressure <90 mmHg). Sociodemographic, clinical and laboratory data, including malaria PCR and rapid diagnostic tests, as well as acid fast bacteria sputum smears and blood cultures were collected. Patients were followed until in-patient death or discharge. The primary outcome of interest was the cause of sepsis. Multivariable logistic regression was performed to assess predictors of mortality. Enrollment included 216 participants who were 51% female with a median age of 32 years (IQR 27–43 years). Of these, 122 (56%) subjects were HIV-seropositive of whom 75 (66%) had a CD4+ T cell count <100 cells/μL. The prevalence of malaria was 4% (six with Plasmodium falciparum, two with Plasmodium vivax). Bacteraemia was identified in 41 (19%) patients. In-hospital mortality was 19% (n = 42). In multivariable regression analysis, Glasgow Coma Score <9 (IRR 4.81, 95% CI 1.80-12.8) and severe sepsis (IRR, 2.07, 95% CI 1.03-4.14), but no specific diagnoses were statistically associated with in-hospital mortality. Malaria was an uncommon cause of adult sepsis in a regional referral hospital in south-western Uganda. In this setting, a thorough evaluation for alternate causes of disease in patients presenting with sepsis is recommended.
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DOI：
10.1016/j.trstmh.2012.05.009
发表时间：
2012-08-01
影响因子：
2.2
作者：
Lofgren, Sarah M.;Kirsch, Emily J.;Crump, John A.
通讯作者：
Crump, John A.
影响因子：
2.7
作者：
Yeka, Adoke;Gasasira, Anne;Rosenthal, Philip J.
通讯作者：
Rosenthal, Philip J.
影响因子：
8.8
作者：
Jacob ST;Banura P;Baeten JM;Moore CC;Meya D;Nakiyingi L;Burke R;Horton CL;Iga B;Wald A;Reynolds SJ;Mayanja-Kizza H;Scheld WM;Promoting Resource-Limited Interventions for Sepsis Management in Uganda Study Group
通讯作者：
Promoting Resource-Limited Interventions for Sepsis Management in Uganda Study Group
DOI：
10.4269/ajtmh.2011.10-0692
发表时间：
2011-10-01
影响因子：
3.3
作者：
Ssekitoleko, Richard;Pinkerton, Relana;Moore, Christopher C.
通讯作者：
Moore, Christopher C.
影响因子：
3
作者：
De Beaudrap, Pierre;Nabasumba, Carolyn;Etard, Jean-Francois
通讯作者：
Etard, Jean-Francois