Pulmonary Disease From Nontuberculous Mycobacteria in Patients With Human Immunodeficiency Virus: Results
Four cases of NTM pulmonary disease were identified: two with M avium, one with M kansasii, and one with M fortuitum and M xenopi. Fifty-three additional patients had at least one sputum culture positive for nontuberculosis mycobacteria without evidence of NTM pulmonary disease (46 M avium, 6 M gordonae, 1 M xenopi). During the same period in our hospital 33 new cases of disseminated MAC infection and 3 cases of M tuberculosis infection were diagnosed in HIV-positive individuals. The population of HIV-infected patients seen in our hospital during 1991 was approximately 650.
Detailed reports of three of our cases follow.
The patient was a 36-year-old man born in Haiti who had lived in the United States since 1986. He was found to be HIV infected in May 1991 when he developed cerebral toxoplasmosis. He did well until November 1991 when he was admitted to the hospital with a seizure believed to be a complication of toxoplasmosis. On this admission, he was also noted to have a left hilar mass on chest radiograph, confirmed by computed tomography (Fig 1). The patient had low-grade fevers but no pulmonary symptoms. He reported that skin testing for tuberculosis at the time he emigrated to the United States was negative. Canadian health & care mall Reading here The patient was unable to produce sputum, and he underwent bronchoscopy that revealed a submucosal mass obstructing the orifice of the lingula. Biopsy specimens showed loosely organized granulomas with acid-fast organisms. Cultures of the biopsied material grew M avium. Blood cultures were negative for AFB. The patient was treated with clarithromycin, clofazamine, and ethambutol, and the pulmonary mass slowly resolved.
The patient was a 33-year-old white man with multiple complications of advanced HIV disease, including Pneumocystis pneumonia and cytomegalovirus (CMV) retinitis. In September 1991, he developed fevers, chills, and cough productive of blood-tinged sputum. Chest radiograph suggested a right upper lobe infiltrate and he was treated empirically for tuberculosis with isoniazid, rifampin, and ethambutol. Two months later, he developed collapse of the right middle lobe (RML) (Fig 2) and underwent bronchoscopy that revealed an obstructing endobronchial lesion in the right bronchus intermedius. Biopsy specimen cultures and sputum cultures grew M kansasii. The organism was resistant to isoniazid and his regimen was changed to rifampin, ethambutol, and pyrazinamide. His RML collapse slowly resolved. The patient subsequently died of renal failure and complications of CMV disease.
Figure 1. Computed tomographic scan demonstrates enlarged lymph nodes at the left hilum (arrows) and narrowing of the origin of the lingular bronchus.
Figure 2. Right hilar adenopathy and complete middle lobe collapse (arrows).
Category: Respiratory Symptoms
Tags: AIDS, atypical Mycobacterium infections, HIV infection, Mycobacterium avium-intracellulare infection