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The microbiologic etiology of severe pneumonia in hospitalized patients is rarely known in sub-Saharan Africa. Through a comprehensive diagnostic work-up, we aimed to identify the causative agent in severely ill patients with a clinical picture of pneumonia admitted to a high-dependency unit. A final diagnosis was made and categorized as confirmed or probable by using predefined criteria. Fifty-one patients were recruited (45% females), with a mean age of 35 years (range = 17–88 years), of whom 11(22%) died. Forty-eight (94%) of the patients were seropositive for human immunodeficiency virus; 14 (29%) of these patients were receiving antiretroviral treatment. Final diagnoses were bacterial pneumonia (29%), Pneumocystis jirovecii pneumonia (27%), pulmonary tuberculosis (22%), and pulmonary Kaposi's sarcoma (16%); 39 (77%) of these cases were confirmed cases. Fifteen (29%) patients had multiple isolates. At least 3 of 11 viral-positive polymerase chain reaction (PCR) results of bronchoalveolar lavage fluid were attributed clinical relevance. No atypical bacterial organisms were found.
Authors' addresses: Thomas K. Hartung, Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin, Berlin, Germany, E-mail: email@example.com. Daniel Chimbayo, Lifeline Malawe, PO Box 41, Chipoka, Salima, Malawi, E-mail: firstname.lastname@example.org. Joep J. G. van Oosterhout and Ed E. Zijlstra, Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi, E-mail: email@example.com and firstname.lastname@example.org. Tarsizio Chikaonda and Malcom E. Molyneux, Malawi-Liverpool Wellcome Trust Clinical Research Program, PO Box 30096, Chichiri, Blantyre 3, Malawi, E-mails: email@example.com and firstname.lastname@example.org. Gerard J. J. van Doornum, Department of Virology, Unit Diagnostics, L359, Erasmus Medical Centre, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands, E-mail: email@example.com. Eric C. J. Claas, Department of Medical Microbiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands, E-mail: firstname.lastname@example.org. Willem J. G. Melchers, Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500HB Nijmegen, The Netherlands, E-mail: email@example.com.