Mycobacterium kansasii in advanced HIV infection - Tips from Other Journals

Date: Sept, 1991

Mycobacterial infections are a primary cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. In the United States, infection with Mycobacterium kansasii is the second most common nontuberculous mycobacterial disease in patients with acquired immunodeficiency syndrome. Levine and Chaisson reviewed the medical records of HIV-positive patients with M. kansasii infection to assess their clinical features and response to therapy.

The study included 19 patients with HIV infection and M. kansasii pneumonia who were treated in an urban teaching hospital during a five-year period. Fourteen of the patients had infections that were limited to the lung, three patients had pulmonary and extrapulmonary infection, and two had extrapulmonary infection exclusively. At the time of diagnosis of M. kansasii infection, the median CD4 T-lymphocyte count was 49 cells per [microliter]. Sixteen of the 19 patients were known to have AIDS at the time of diagnosis.

All 17 patients with pulmonary infection presented with fever and cough of at least two weeks' duration. Chest radiographs showed focal upper lobe infiltrates in eight patients and diffuse interstitial infiltrates in nine patients. Nine patients also had thin-walled cavitary lesions.

Nine patients with pulmonary M. kansasii infection were treated with antituberculosis chemotherapy, which resulted in resolution of fever and respiratory symptoms, improvement of radiographic infiltrates and clearing of sputum. One patient with M. kansasii osteomyelitis also responded to antituberculosis therapy. No evidence of M. kansasii infection was found at autopsy in three of the treated patients.

Nine patients did not receive antituberculosis chemotherapy. Two untreated patients died of progressive cavitary pulmonary disease.

The authors believe that M. kansasii may cause serious, potentially life-threatening pulmonary disease in patients with AIDS. M. kansasii infection in AIDS patients is responsive to antituberculosis chemotherapy. (Annals of Internal Medicine, May 15, 1991, vol. 114, p. 861.)

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