Community-onset febrile illness in HIV-infected adults: Variable pathogens in terms of CD4 counts and transmission routes

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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.

Original languageEnglish
Pages (from-to)80-87
Number of pages8
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number1
DOIs
Publication statusPublished - 2015 Jan 1

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CD4 Lymphocyte Count
Fever
HIV
Soft Tissue Infections
Hospital Emergency Service
Respiratory Tract Infections
Skin
Pneumonia
Odds Ratio
Intraabdominal Infections
Pneumocystis carinii
Infection
Taiwan
Urinary Tract Infections
Pharmaceutical Preparations
Staphylococcus aureus
Multivariate Analysis
Lung
Injections

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

@article{2bca4a6bf45345fd80f78eb0d2828c68,
title = "Community-onset febrile illness in HIV-infected adults: Variable pathogens in terms of CD4 counts and transmission routes",
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.",
author = "Lee, {Ching Chi} and Chih-Chia Hsieh and Tsung-Yu Chan and Po-Lin Chen and Chih-Hsien Chi and Wen-Chien Ko",
year = "2015",
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doi = "10.1016/j.ajem.2014.10.013",
language = "English",
volume = "33",
pages = "80--87",
journal = "American Journal of Emergency Medicine",
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T1 - Community-onset febrile illness in HIV-infected adults

T2 - Variable pathogens in terms of CD4 counts and transmission routes

AU - Lee, Ching Chi

AU - Hsieh, Chih-Chia

AU - Chan, Tsung-Yu

AU - Chen, Po-Lin

AU - Chi, Chih-Hsien

AU - Ko, Wen-Chien

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

AB - 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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