Mycobacterium avium complex (MAC) infection in severely immunocompromised people living with HIV: Findings from a
María Del Rocío Fernández-Díaz1, Naya Faro-Miguez1, María Aguilera-Franco2
1Infectious Diseases Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain.
Background:
We sought to clarify the current incidence, risk factors and symptoms of disseminated Mycobacterium avium complex (dMAC) infection in admitted people living with HIV in a hospital in the Southeast of Spain.
Methods:
5-years observational, retrospective and single-centre study. Demographic, clinical and analytical variables, along with microbiological, treatment and follow-up were collected.
Results:
Five cases of dMAC infection in severely immunocompromised people living with HIV people living were found. dMAC was diagnosed in 22.7% of patients under 100 CD4. All patients presented with fever and clinical manifestations of pneumonia, lymphadenopathy, or gastrointestinal symptoms. Despite low CD4 levels and high viral loads in some cases, primary prophylaxis had not been previously administered.
Conclusions:
Until 2018, U.S. American guidelines recommended antimycobacterial prophylaxis for patients with low CD4 cell counts, a practice not adopted in Europe. Untreated dMAC infection is associated with high morbidity and mortality rates. dMAC infection represents a prevalent disease in severely immunosuppressed people living with HIV. dMAC requires a high index of suspicion in this population, in order to perform mycobacterial cultures from different samples.
Insights
Disseminated Mycobacterium avium complex (dMAC) infection is prevalent in severely immunocompromised people living with HIV. Early suspicion and mycobacterial cultures are crucial for diagnosis and management.
Area of Science:
- Infectious Diseases
- Immunology
- Public Health
Background:
- Disseminated Mycobacterium avium complex (dMAC) infection poses a significant threat to people living with HIV (PLWHIV).
- Understanding the current incidence, risk factors, and symptoms of dMAC in PLWHIV is essential for effective clinical management.
- This study focuses on PLWHIV admitted to a hospital in Southeast Spain.
Purpose of the Study:
- To clarify the current incidence of dMAC infection in admitted PLWHIV.
- To identify risk factors associated with dMAC infection in this population.
- To describe the clinical manifestations and symptoms of dMAC in hospitalized PLWHIV.
Main Methods:
- A 5-year observational, retrospective, single-centre study was conducted.
- Demographic, clinical, and analytical data were collected.
- Microbiological, treatment, and follow-up information was systematically gathered.
Main Results:
- Five cases of dMAC infection were identified in severely immunocompromised PLWHIV.
- dMAC was diagnosed in 22.7% of patients with CD4 counts below 100 cells/µL.
- Common symptoms included fever, pneumonia, lymphadenopathy, and gastrointestinal issues; primary prophylaxis was often not administered despite low CD4 counts.
Conclusions:
- dMAC infection remains a prevalent concern in severely immunosuppressed PLWHIV.
- A high index of suspicion is necessary for timely diagnosis, necessitating mycobacterial cultures from diverse samples.
- While US guidelines recommended prophylaxis, this practice was not widely adopted in Europe, highlighting a potential gap in care.
Related Concept Videos
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:25Immunodeficiency Diseases
There are three main causes of immunodeficiency...
01:31Pulmonary Tuberculosis III
The first classification is based on the development of the disease, and it includes the following categories:
01:28Pulmonary Tuberculosis II
Here is a detailed explanation of its pathophysiology:
Transmission: The process begins when a person inhales droplet nuclei containing M. tuberculosis. These are typically released into the air when an individual with pulmonary or...
01:26Pulmonary Tuberculosis IV
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...