Archive for July 22, 2013

Site of Extrapulmonary Tuberculosis is Associated with HIV Infection

Clinical Infectious Diseases July 1, 2012 V.55 N.1 P.75-81

Ira L. Leeds1, Matthew J. Magee2, Ekaterina V. Kurbatova3, Carlos del Rio1,2,3, Henry M. Blumberg1,2,3, Michael K. Leonard1,3, and Colleen S. Kraft1,3,4

1Emory University School of Medicine

2Departments of Epidemiology and Global Health, Rollins School of Public Health

3Division of Infectious Diseases, Department of Medicine

4Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA

Correspondence: Ira Leeds, AB, Emory University School of Medicine, 1648 Pierce Drive, Atlanta, GA 30322 (


In the United States, the proportion of patients with extrapulmonary tuberculosis (EPTB) has increased relative to cases of pulmonary tuberculosis. Patients with central nervous system (CNS)/meningeal and disseminated EPTB and those with human immunodeficiency virus (HIV)/AIDS have increased mortality. The purpose of our study was to determine risk factors associated with particular types of EPTB.


We retrospectively reviewed 320 cases of EPTB from 1995–2007 at a single urban US public hospital. Medical records were reviewed to determine site of EPTB and patient demographic and clinical characteristics. Multivariable logistic regression analyses were performed to determine independent associations between patient characteristics and site of disease.


Patients were predominantly male (67%), African American (82%), and US-born (76%). Mean age was 40 years (range 18–89). The most common sites of EPTB were lymphatic (28%), disseminated (23%), and CNS/meningeal (22%) disease. One hundred fifty-four (48.1%) were HIV-infected, 40% had concomitant pulmonary tuberculosis, and 14.7% died within 12 months of EPTB diagnosis. Multivariable analysis demonstrated that HIV-infected patients were less likely to have pleural (adjusted odds ratio [AOR] 0.3; 95% confidence interval [CI] .2, .6) as site of EPTB disease than HIV-uninfected patients. Among patients with EPTB and HIV-infection, patients with CD4 lymphocyte cell count <100 were more likely to have severe forms of EPTB (CNS/meningeal and/or disseminated) (AOR 1.6; 95% CI, 1.0, 2.4).


Among patients hospitalized with EPTB, patients coinfected with HIV and low CD4 counts were more likely to have CNS/meningeal and disseminated disease. Care for similar patients should include consideration of these forms of EPTB since they carry a high risk of death.


July 22, 2013 at 9:02 am

Q Fever Pneumonia in French Guiana: Prevalence, Risk Factors, and Prognostic Score

Clinical Infectious Diseases July 1, 2012 V.55 N.1 P.67-74

Loïc Epelboin1,3,a, Cédric Chesnais1,4,a, Charlotte Boullé4, Anne-Sophie Drogoul2, Didier Raoult5, Félix Djossou1, and Aba Mahamat1

1Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon

2Institut Pasteur de Guyane, Cayenne, French Guiana

3Department of Infectious and Tropical Diseases, Centre Hospitalier Pitié-Salpêtrière, Paris

4UMI 233, Institut de Recherche pour le Développement (IRD)/Université Montpellier 1 (UM1), Montpellier

5URMITE UMR CNRS IRD 6236 IFR 48, Faculté de Médecine, Université de la Méditerranée, Marseille, France

Correspondence: Dr Aba Mahamat, MD, PhD, UMIT, CH Andrée Rosemon, Rue des Flamboyants, 97306 Cayenne, Guyane Française, France (


Community-acquired pneumonia (CAP) is the major manifestation of Q fever, an emerging disease in French Guiana. Consequently, the empirical antibiotherapy used for the treatment of CAP combines doxycycline and the recommended amoxicillin. Our objectives were to estimate the prevalence of Q fever pneumonia and to build a prediction rule to identify patients with Q fever pneumonia for empirical antibiotic guidance.


A retrospective case-control study was conducted on inpatients admitted with CAP in the Department of Infectious Diseases of Cayenne Hospital from 2004 to 2007. Serodiagnosis for Coxiella burnetii was performed for all patients. Risk factor analysis was performed using multivariate logistic regression, and a prognostic score was computed using bootstrap procedures. The score performance characteristics were used to choose the best prediction rule to identify patients with Q fever pneumonia.


One hundred thirty-one patients with CAP were included and the Q fever pneumonia prevalence was 24.4% (95% confidence interval [CI], 17.1–31.9). In multivariate analysis, male sex, middle age (age, 30–60 years), headache, leukocyte count <10 × 109/L and C-reactive protein level >185 mg/L were independently associated with Q fever pneumonia. Patients with a predictive score ≤3 had a low risk of Q fever pneumonia with a negative predictive value of 0.97 (95% CI, .90–1) and a sensitivity of 0.97 (95% CI, .89–1).


The prediction rule described here accurately identifies patients with low risk of Q fever pneumonia and may help physicians to make more rational decisions about the empirical use of antibiotherapy. Further prospective studies should be performed to validate this score.


July 22, 2013 at 8:59 am


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