Pulmonary Disease From Nontuberculous Mycobacteria in Patients With Human Immunodeficiency Virus: Conclusions
In spite of the difficulties imposed by the rarity of the disease and the difficulties with diagnostic criteria, it seems clear that the radiographic appearance of NTM in AIDS is not that seen in immunocompetent hosts; cavitation is uncommon and the indolent “fibronod-ular” form is not seen.
There is considerable overlap in the radiographic appearance of M tuberculosis and NTM pulmonary infections in AIDS. In our patients, central lesions with atelectasis suggested the diagnosis of mycobacterial disease, but not specifically NTM more canadian family pharmacy. It cannot be concluded that there are any specific findings on chest radiograph that confirm or exclude the diagnosis of mycobacterial disease or that distinguish MTb from NTM infection. In patients with AIDS who present with undiagnosed pulmonary infection, a high index of suspicion for mycobacterial disease and a careful search for the causative organism are warranted by public health concerns (in the case of MTb) and by the fact that some of these infections, when confined to the lung, are both life-threatening and treatable.
We suggest that NTM pulmonary disease should be considered in patients with advanced HIV disease who present with positive sputum cultures and/or disseminated mycobacterial disease along with radiographic evidence of lung disease. In the appropriate clinical setting, if expectorated sputum samples are nondiagnostic, bronchoalveolar lavage and transbronchial biopsy specimen examined and cultured for acid-fast organisms should be pursued. The presence of NTM in pulmonary specimens cannot be assumed to represent infection without clinical or radiologic evidence of pulmonary disease. Since these infections are rare, even among patients with HIV, other pulmonary infections should be ruled out. Patients with AIDS with pulmonary disease and sputum smears positive for AFB should be assumed to have tuberculosis until this diagnosis can be excluded. Patient isolation does not need to be continued if a NTM organism is identified, since person-to-person spread of these infections does not occur.
There is not sufficient clinical experience to generalize about results of treatment of NTM pulmonary disease in AIDS. There are, however, case reports of good response to treatment. Response will probably depend to some extent on the level of immunosuppression, functional level, nutritional status, and the presence of other HIV complications; decisions about whether and how to treat will need to be individualized. At least in the case of M kansasii, isolated pulmonary disease may respond more favorably to treatment than disseminated infection.
Category: Respiratory Symptoms
Tags: AIDS, atypical Mycobacterium infections, HIV infection, Mycobacterium avium-intracellulare infection