Pulmonary Disease From Nontuberculous Mycobacteria in Patients With Human Immunodeficiency Virus: Methods
Nontuberculous mycobacterial species (NTM) are common environmental organisms and occasional colonizers of the human respiratory system. Timpe and Runyon and others in the 1950s established the potential pathogenicity of these organisms in human disease and created a widely used classification system based on morphologic, physiologic, and biochemical characteristics Here buy proventil. Since then, chronic bronchopulmonary disease resulting from infection with several of these species has been well described. More recently, disseminated infection, particularly with Mycobacterium avium complex (MAC) organisms, has become a common complication of infection with the human immunodeficiency virus (HIV). In HIV-infected individuals, pulmonary NTM infections may occur alone or in the presence of disseminated disease. The purpose of this report is to present several cases of pulmonary NTM disease in patients with HIV and to review the literature on this subject.
Reported cases were all seen at Yale-New Haven Hospital, a community tertiary care facility with a diverse population of HIV-infected patients. Cases were identified through review of the microbiology reports from 1991 with attention to isolates of NTM from sputum, bronchial lavage fluid, or lung biopsy specimens. Clinical information was obtained from review of hospital and outpatient charts, radiologic files, and pathology specimens. Reported cases all had documentation of HIV infection with standard serologic testing. Cases were selected based on the presence of at least two positive mycobacterial cultures from pulmonary specimens with radiographic evidence of pulmonary disease (infiltrate, mass, or pleural effusion) and no other etiology identified.
Identification of NTM was performed with standard laboratory methods. Briefly, specimens were examined for the presence of acid-fast bacilli (AFB) using Kenyoun stain and fluorescent-auramine staining. Growth of organisms was detected by a radiometric system (Bactec, Becton Dickenson Diagnostic, Towson, Md) and preliminary identification of M tuberculosis and MAC performed with specific nucleic acid probes (Gen-Probe, San Diego, Calif). Final identification was accomplished with standard biochemical tests.
Review of English language literature was performed using the MEDLINE database.
Category: Respiratory Symptoms
Tags: AIDS, atypical Mycobacterium infections, HIV infection, Mycobacterium avium-intracellulare infection