Disseminated mycobacteriosis in patients with severe hematologic disorders

During a 20-year period disseminated mycobacteriosis occurred in 11 (1.1%) of a total of 1006 patients with severe hematologic disorders, with the frequency remaining almost unchanged. The diagnosis in three patients (27%) was made only at autopsy. Tuberculosis accounted for 64% of all cases. Female preponderance was seen with a male-to-female ratio of 3:8. The major factors associated with dissemination included immunosuppression, weight loss, old age, and diabetes mellitus. Fever was the most common clinical symptom. Chest X-ray abnormalities, hypoproteinemia, liver dysfunction, and hypoxemia were noted in most cases. The prognosis of tuberculosis depended mainly on early diagnosis and treatment, while that for the nontuberculous variety was largely influenced by the underlying disease. Thus, our findings indicated that clinicians must suspect disseminated mycobacteriosis especially in any febrile patient with recent pulmonary pathology on chest X-ray, so that an adequate trial of therapy can be provided.