Blood infection, medically known as sepsis, is one of the leading causes of death because the body’s response to infection damages tissue and causes organs to fail.
Africa has the highest number of sepsis patients in the world, with an estimated 48 million cases per year, leading to approximately 11 million deaths. People with HIV are at the greatest risk of dying from this condition.
A new study has found that tuberculosis, a chronic bacterial lung disease, is a leading and long-overlooked cause of fatal sepsis in people with HIV.
A related Phase 3 clinical trial, called the ATLAS trial, found that immediately initiating tuberculosis (TB) treatment, even before a TB diagnosis is confirmed, could significantly reduce sepsis deaths among HIV patients.
The study and the ATLAS study were conducted by Tulane University and University of Virginia in collaboration with Mbarara University in Uganda and Kibong’oto Infectious Diseases Hospital in Tanzania, among others. The findings from the study and clinical trial were published in Lancet E-Clinical Medicine and Lancet Infectious Disease, respectively.
“Our analysis of the clinical trial results showed that Mtb (the bacteria that causes tuberculosis) is a much more common cause of sepsis than we thought,” said Dr. Eva Otoupalova, assistant professor of Pulmonary and Critical Care Medicine at Tulane University School of Medicine, who co-led the study and was also an author of the ATLAS study.
“Typically, anti-TB treatments are reserved for people diagnosed with tuberculosis. We have found that patients with sepsis in African hospitals where HIV and tuberculosis are common co-infections may benefit from receiving anti-TB drugs as soon as possible,” the expert added.
In the follow-up study results, Mtb was the most common pathogen, detected in 52% of HIV-related sepsis patients.
Dr. Eva said: “Previous studies have shown that tuberculosis can cause sepsis, but these are few, and I don’t think we realized how high the prevalence is. Our analysis has also shown that our diagnostic tools miss many tuberculosis sepsis, which has an impact if anti-TB treatment is only given to those diagnosed with the disease.”
It is known that tuberculosis can be difficult to detect in children, the elderly, people with HIV and people with pulmonary tuberculosis. These are all cases where the sputum needed for testing is more difficult to obtain. However, the researchers found that combined urine and sputum tests missed 32% of Mtb bloodstream infections.
These findings highlight the need for both earlier treatment and improved diagnostic tools for tuberculosis.
“These studies underscore two things: first, we have successfully intervened in tuberculosis-related sepsis, and second, we have used every rapid test available and found that they simply do not detect all MTB,” concluded Dr. Eva Otoupalova.
