Pulmonary Disease From Nontuberculous Mycobacteria in Patients With Human Immunodeficiency Virus: Mycobacterium fortuitum
Mycobacterium fortuitum and M chelonae are classified as rapidly growing mycobacteria. These are ubiquitous environmental organisms; human infections are most commonly associated with direct inoculation of organisms via surgery, trauma, or in association with foreign bodies. Although bronchopulmonary infections may result from aspiration of the organisms, isolation of the rapidly growing mycobacteria from respiratory specimens is more commonly due to colonization than to infection.
In the previously cited review by Shafer and Sierra, only 15 percent of isolates of M fortuitum and M chelonae were from patients with HIV infection. Several case reports have described disseminated disease due to M fortuitum in patients with AIDS. Lambert and Baddour reported a case of a 28-year-old woman with HIV infection who developed a RML infiltrate with hilar adenopathy; open lung biopsy specimen revealed AFB that proved to be M fortuitum. The patient’s disease progressed despite antituberculous therapy and she developed obstruction of the bronchus intermedius. She eventually required thoracotomy with resection of the right middle and right lower lobes. There was no evidence of AFB in spinal fluid or bone marrow.
Mycobacterium malmoense was first described in 197726 and has since been recognized as a rare cause of human disease. Pulmonary disease resembling tuberculosis is the most common manifestation, with rare reports of extrapulmonary and disseminated infection. Reports of clinically significant M malmoense infection in patients with AIDS have been even more rare. Two published reports describe HIV-infected patients with pulmonary and disseminated infection. Successful treatment with standard antituberculous drugs has been reported, but there is generally poor correlation between in vitro susceptibility and in vivo response to treatment.
Category: Respiratory Symptoms
Tags: AIDS, atypical Mycobacterium infections, HIV infection, Mycobacterium avium-intracellulare infection