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The spectrum of Mycobacterium kansasii disease associated with HIV-1 infected patients
G T Valainis1, L M Cardona, D L Greer
1Infectious Disease Section, Tulane University Medical Center, New Orleans, Louisiana.
Abstract:
Louisiana is known to be an area endemic for Mycobacterium kansasii (MK). Since MK tends to disseminate in immunocompromised patients, one might, therefore, expect to observe an increasing number of MK infections associated with human immunodeficiency virus (HIV-1). A systematic 60-month review of clinical, microbiologic, and radiographic data associated with MK was performed from two major referral centers in New Orleans. From June 30, 1983 through June 30, 1988, MK was isolated from 72 patients. Twenty-three of the 72 (31.9%) were found to be coinfected with HIV-1. Over the 5-year study period, the phenomenon of dual infection increased from 0 to 50%. Six cases of extrapulmonary infection were found among the HIV-1 patients as compared to 1 in 49 non-HIV patients (p = 0.003, Fisher's exact test). In addition, patients with dual infection had atypical chest radiographs, usually with interstitial infiltrates without cavitation. Most of these patients died within 12 months (90.9%). When treatment was administered at all, often it varied considerably from patient to patient despite the well-known in vitro efficacy of certain widely available anti-mycobacterial agents.
Insights
Mycobacterium kansasii (MK) infections are increasing in HIV-1 patients in Louisiana. Dual infections rose significantly, leading to atypical radiographs and poor survival rates, often with varied treatment approaches.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Louisiana is an endemic area for Mycobacterium kansasii (MK).
- Human immunodeficiency virus (HIV-1) infection is a known risk factor for disseminated MK infections.
- An increasing incidence of coinfection was hypothesized.
Purpose of the Study:
- To review clinical, microbiologic, and radiographic data of MK infections over a 60-month period.
- To determine the prevalence and impact of HIV-1 coinfection in MK cases.
- To analyze outcomes and treatment patterns in coinfected patients.
Main Methods:
- Systematic review of patient data from two referral centers.
- Analysis of clinical, microbiologic, and radiographic findings.
- Statistical comparison between HIV-1 coinfected and non-HIV-1 patients.
Main Results:
- MK was isolated from 72 patients; 31.9% were coinfected with HIV-1.
- The rate of dual infection increased from 0% to 50% over the study period.
- HIV-1 coinfected patients had higher rates of extrapulmonary MK (p = 0.003), atypical chest radiographs (interstitial infiltrates without cavitation), and mortality (90.9% within 12 months).
Conclusions:
- HIV-1 coinfection significantly impacts the presentation and outcome of Mycobacterium kansasii infections.
- Atypical radiographic findings and high mortality are characteristic of dual infections.
- Treatment approaches varied considerably, despite known effective anti-mycobacterial agents.