Departments of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
Correspondence
Corresponding author. Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, 70403, Tainan, Taiwan. Tel.: +886 6 2353535x3596; fax: +886 6 2752038.
Departments of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
Correspondence
Corresponding author. Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, 70403, Tainan, Taiwan. Tel.: +886 6 2353535x3596; fax: +886 6 2752038.
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Figures
Fig. 1
The clinical diagnosis of infectious diseases (A) and causative microorganisms (B) among HIV-infected adults with community-onset febrile illness.
Fig. 2
The trends of major 5 pathogens among 148 HIV-infected adults with community-onset febrile illness, with regard to an increasing CD4 count. P values were calculated by the Pearson correlation.
Fig. 3
The distribution of transmission risk among 148 HIV-infected adults with community-onset febrile illness, as categorized by major 5 pathogens, after the exclusion of 39 patients without recognized pathogens and 10 with noninfectious illness. Asterisk indicates P < .05, calculated by the χ2 test.
Abstract
Objectives
The objective of the study is to investigate the causes of febrile illness among HIV-infected adults visiting the emergency department (ED) of a designated hospital for HIV care in Taiwan, an area of a low HIV prevalence.
Methods
From January 2004 to December 2012, all febrile HIV-infected adults visiting the ED were retrospectively investigated. Recent CD4 lymphocyte counts near ED visits and HIV transmission route were designated as major predictors for the analyses. All variables and clinical information were derived from chart records.
Results
Of the 196 eligible HIV-infected adults, major causes of febrile illness were lower respiratory tract infections (68, 34.7%), skin and soft tissue infections (31, 15.8%), intra-abdominal infections (22, 11.2%), and urinary tract infections (11, 5.6%). There were 150 pathogens identified. Staphylococcus aureus (51, 34.0%) and Pneumocystis jirovecii (26, 17.3%) were the major pathogens. In a multivariate analysis, injection drug use (odds ratio, 15.18; P < .001) and skin and soft tissue infections (odds ratio, 18.45; P = .001) were independently associated with S aureus infections, and the proportion of S aureus increased steadily with CD4 lymphocyte count (γ = 0.99; P = .01). Of pneumonic patients with recognized pathogens, P jirovecii pneumonia was frequently associated with patients having a CD4 lymphocyte count of less than 100 cells/mm3 (25/25, 100% vs 16/30, 53.3%; P < .001).
Conclusions
The causes of febrile illness in HIV-infected adults visiting the ED varied according to CD4 count and transmission route. Two independent risk factors, intravenous drug use and skin and soft tissue infections, were associated with S aureus infections. For HIV-infected adults with lower respiratory tract infections, a CD4 lymphocyte count of less than 100 cells/mm3 was a risk factor for P jirovecii pneumonia.
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☆Funding: This study was partially supported by grants from the Ministry of Health and Welfare Taiwan ( MOHW103-TDU-B-211-113002 ) and, in part, supported by a research grant from the Ministry of Science and Technology Taiwan ( NSC102-2314-B-006 -079 ).
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