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.authorKnight, Laurenen_ZA
dc.contributor.authorMuloiwa, Rudzanien_ZA
dc.contributor.authorDlamini, Siphoen_ZA
dc.contributor.authorLehloenya, Rannakoe Jen_ZA
dc.date.accessioned2015-11-23T12:37:22Z
dc.date.available2015-11-23T12:37:22Z
dc.date.issued2014en_ZA
dc.description.abstractStevens-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.identifier.apacitationKnight, 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/11427/15355en_ZA
dc.identifier.chicagocitationKnight, 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/11427/15355en_ZA
dc.identifier.citationKnight, 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.0093543en_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
dc.identifier.urihttp://hdl.handle.net/11427/15355
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0093543
dc.identifier.vancouvercitationKnight 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.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDepartment of Paediatrics and Child Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2014 Knight et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherGram negative bacteriaen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherSkin infectionsen_ZA
dc.subject.otherBlooden_ZA
dc.subject.otherOpportunistic infectionsen_ZA
dc.subject.otherBacterial pathogensen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherRetrospective studiesen_ZA
dc.titleFactors associated with increased mortality in a predominantly HIV-infected population with Stevens Johnson syndrome and toxic epidermal necrolysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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