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Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome. A clinicopathologic
1Pulmonary Division, University of California School of Medicine, Los Angeles.
Abstract:
Despite the recognition of Mycobacterium avium complex (MAC) infection as a common complication of AIDS, the specific clinical features, significance, and need for treatment have been difficult to assess. We reviewed the clinical records and autopsy material of 68 patients dying with AIDS, 32 (47 percent) of whom had MAC isolated from autopsy tissue. All had postmortem evidence of systemic infection. Eleven (34 percent) had MAC isolated from lung tissue. Little, if any, local tissue inflammation and destruction were associated with MAC infection. Patients with autopsy evidence of MAC infection had a longer time interval from diagnosis of AIDS to death. The infection was detected antemortem in 14 (44 percent), blood culture being the most sensitive means (86 percent yield). Although recurrent fever was noted among both MAC infected and uninfected patients, weight loss greater than 20 lb, weakness, anorexia, abdominal pain, and diarrhea were more frequent among infected patients. Severe anemia, thrombocytopenia, lymphopenia, and reduced mean CD-4 percentages and CD-4/CD-8 ratios were associated with MAC infection. Of eight patients who had MAC cultured antemortem and received multidrug antituberculosis therapy, none responded clinically, and all but one had MAC isolated at autopsy. Because MAC is associated with significant discomfort and disability, development of more effective treatment regimens could be beneficial for some affected AIDS patients.
Insights
Mycobacterium avium complex (MAC) is a common complication in AIDS patients, often causing systemic infection. Current treatments show limited efficacy, highlighting the need for improved therapeutic strategies.
Area of Science:
- Infectious Diseases
- Immunology
- Pathology
Background:
- Mycobacterium avium complex (MAC) is a frequent complication in Acquired Immunodeficiency Syndrome (AIDS).
- Assessing the clinical impact, significance, and optimal treatment for MAC in AIDS patients remains challenging.
Purpose of the Study:
- To investigate the clinical features, pathological findings, and treatment outcomes of Mycobacterium avium complex (MAC) infection in patients with Acquired Immunodeficiency Syndrome (AIDS).
Main Methods:
- Retrospective review of clinical records and autopsy materials from 68 patients with AIDS.
- Analysis of MAC isolation from autopsy tissues and antemortem detection methods.
- Evaluation of clinical symptoms, laboratory data, and treatment responses.
Main Results:
- MAC infection was present in 47% of deceased AIDS patients, with systemic involvement in all cases.
- Antemortem diagnosis was achieved in 44% of cases, with blood cultures showing 86% sensitivity.
- MAC infection was associated with longer survival post-AIDS diagnosis, specific clinical symptoms (weight loss, weakness, anorexia, abdominal pain, diarrhea), and hematological abnormalities (anemia, thrombocytopenia, lymphopenia).
- Multidrug antituberculosis therapy showed no clinical response in patients treated antemortem.
Conclusions:
- Mycobacterium avium complex (MAC) infection is a significant systemic complication in AIDS patients, associated with specific clinical manifestations and laboratory findings.
- Current multidrug antituberculosis therapies demonstrate limited efficacy in treating MAC infection in this population.
- Further research into developing more effective treatment regimens for MAC infection in AIDS patients is warranted to alleviate patient discomfort and disability.