Pulmonary Disease From Nontuberculous Mycobacteria in Patients With Human Immunodeficiency Virus: M tuberculosis
This is in distinct contrast to patients without AIDS as noted by Prince et al who identified a group of 21 patients with MAC pulmonary disease without predisposing conditions. Nodular opacities were noted in 71 percent and cavitary changes were noted in 25 percent. Hawkins et al reviewed 67 patients with MAC and HIV and noted that neither cavitary changes nor effusions suggestive of mycobacterial disease were seen. Modilevsky et al reviewed the radiographic manifestations of MAC in their comparison of MAC with MTb infections in HIV-infected patients. Interstitial infiltrates were noted in 50 percent of patients, alveolar infiltrates in 21 percent, and cavities in 4 percent (one patient). Lymphadenopathy was seen in 11 percent and effusions in none website mycanadianpharmacy.com. These authors note that the diagnosis was suggested on the chest radiograph in only 25 percent compared with 83 percent with M tuberculosis.
Carpenter and Parks, reviewing M kansasii infections in patients seropositive for HIV, demonstrated the diversity of pulmonary manifestations: alveolar and interstitial infiltrates as well as masses, nodules, and nodes were described. The majority of patients had concomitant opportunistic infections further complicating the radiologic picture. In contrast to the series and review of Carpenter and Parks, Levine and Chaisson noted the presence of single or multiple thin-walled cavities superimposed on either upper lobe or diffuse disease. Only two of these nine patients had other associated infections.
The epidemic of HIV infection has been associated with a concurrent increase in disease due to nontu-berculous mycobacterial organisms. Many of these organisms were previously believed to be of low pathogenicity, and their isolation from respiratory specimens frequently attributed to colonization or contamination. Patients with HIV infection, however, appear to have a unique propensity for infection with all mycobacterial species. The potential for dissemination of NTM infections in patients with AIDS is also increased. Apart from M tuberculosis, however, the pulmonary manifestations of mycobacterial infection in AIDS have not been well described. The cases in this report and the review of the literature illustrate the potential for significant pulmonary infection with NTM as a complication of HIV infection.
Category: Respiratory Symptoms
Tags: AIDS, atypical Mycobacterium infections, HIV infection, Mycobacterium avium-intracellulare infection