Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis

 

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dc.contributor.author Knight, Lauren en_ZA
dc.contributor.author Muloiwa, Rudzani en_ZA
dc.contributor.author Dlamini, Sipho en_ZA
dc.contributor.author Lehloenya, Rannakoe J en_ZA
dc.date.accessioned 2015-11-23T12:37:22Z
dc.date.available 2015-11-23T12:37:22Z
dc.date.issued 2014 en_ZA
dc.identifier.citation Knight, L., Muloiwa, R., Dlamini, S., & Lehloenya, R. J. (2013). Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis. PloS one, 9(4), e93543. doi:10.1371/journal.pone.0093543 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15355
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0093543
dc.description.abstract Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug reactions with a higher incidence in HIV-infected persons. SJS/TEN are associated with skin and mucosal failure, predisposing to systemic bacterial infection (BSI), a major cause of death. There are limited data on risk factors associated with BSI and and mortality in HIV-infected people with SJS/TEN. METHODS: We conducted a retrospective study of patients admitted to a university hospital with SJS/TEN over a 3 year period. We evaluated their underlying illnesses, eliciting drugs, predictive value of bacterial skin cultures and other factors associated with mortality and BSI in a predominantly HIV-infected population by comparing characteristics of the patients who demised and those who survived. RESULTS: We admitted 86 cases during the study period and 67/86(78%) were HIV-infected. Tuberculosis was the commonest co-morbidity, diagnosed in 12/86(14%) cases. Skin cultures correlated with BSI by the same organism in 7/64(11%) cases and 6/7 were Gram-negative. Two of the 8 cases of Gram-negative BSI had an associated Gram-negative skin culture, although not always the same organism. All 8 fatalities had >30% epidermal detachment, 7 were HIV-infected, 6 died of BSI and 6 had tuberculosis. CONCLUSIONS: Having >30% epidermal detachment in SJS/TEN carries an increased risk of BSI and mortality. Tuberculosis and BSI are associated with higher risk of death in SJS/TEN. Our data suggests there may be an association between Gram-negative BSI and Gram-negative skin infection. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Gram negative bacteria en_ZA
dc.subject.other Tuberculosis en_ZA
dc.subject.other Skin infections en_ZA
dc.subject.other Blood en_ZA
dc.subject.other Opportunistic infections en_ZA
dc.subject.other Bacterial pathogens en_ZA
dc.subject.other HIV en_ZA
dc.subject.other Retrospective studies en_ZA
dc.title Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2014 Knight et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Paediatrics and Child Health en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Knight, L., Muloiwa, R., Dlamini, S., & Lehloenya, R. J. (2014). Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis. <i>PLoS One</i>, http://hdl.handle.net/11427/15355 en_ZA
dc.identifier.chicagocitation Knight, Lauren, Rudzani Muloiwa, Sipho Dlamini, and Rannakoe J Lehloenya "Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/15355 en_ZA
dc.identifier.vancouvercitation Knight L, Muloiwa R, Dlamini S, Lehloenya RJ. Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis. PLoS One. 2014; http://hdl.handle.net/11427/15355. en_ZA
dc.identifier.ris TY - Journal Article AU - Knight, Lauren AU - Muloiwa, Rudzani AU - Dlamini, Sipho AU - Lehloenya, Rannakoe J AB - Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug reactions with a higher incidence in HIV-infected persons. SJS/TEN are associated with skin and mucosal failure, predisposing to systemic bacterial infection (BSI), a major cause of death. There are limited data on risk factors associated with BSI and and mortality in HIV-infected people with SJS/TEN. METHODS: We conducted a retrospective study of patients admitted to a university hospital with SJS/TEN over a 3 year period. We evaluated their underlying illnesses, eliciting drugs, predictive value of bacterial skin cultures and other factors associated with mortality and BSI in a predominantly HIV-infected population by comparing characteristics of the patients who demised and those who survived. RESULTS: We admitted 86 cases during the study period and 67/86(78%) were HIV-infected. Tuberculosis was the commonest co-morbidity, diagnosed in 12/86(14%) cases. Skin cultures correlated with BSI by the same organism in 7/64(11%) cases and 6/7 were Gram-negative. Two of the 8 cases of Gram-negative BSI had an associated Gram-negative skin culture, although not always the same organism. All 8 fatalities had >30% epidermal detachment, 7 were HIV-infected, 6 died of BSI and 6 had tuberculosis. CONCLUSIONS: Having >30% epidermal detachment in SJS/TEN carries an increased risk of BSI and mortality. Tuberculosis and BSI are associated with higher risk of death in SJS/TEN. Our data suggests there may be an association between Gram-negative BSI and Gram-negative skin infection. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0093543 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis TI - Factors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysis UR - http://hdl.handle.net/11427/15355 ER - en_ZA


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.