Non-Tuberculous Mycobacterial Infection in AIDS Patients: A Detailed Description of 4 Cases, Including...

Area of Science:

• Infectious Diseases
• Immunology
• Microbiology

Background:

• Non-tuberculous mycobacteria (NTM) are significant opportunistic pathogens in individuals with Acquired Immunodeficiency Syndrome (AIDS).
• Disseminated NTM infections pose a considerable challenge in managing AIDS patients, often presenting with complex clinical manifestations.

Purpose of the Study:

• To report on four cases of disseminated NTM infections in patients diagnosed with AIDS.
• To highlight the clinical presentation, diagnostic challenges, treatment strategies, and outcomes associated with these infections.

Main Methods:

• Case series presentation of four AIDS patients with disseminated NTM infections.
• Diagnostic methods included blood cultures, bone marrow aspirates, sputum analysis, bronchoalveolar lavage, PCR, and histopathology.
• Treatment involved long-term combination antimicrobial therapy, including ethambutol, macrolides, quinolones, amikacin, and rifampicin, with adjustments for antiretroviral therapy (ART).

Main Results:

• Patients presented with prolonged fever, weight loss, diarrhea, cough, hepatosplenomegaly, anemia, and thrombocytopenia.
• Low CD4 counts and interrupted ART were common factors; three patients had discontinued ART.
• Mycobacterium avium and Mycobacterium genavense were identified; three patients survived, one died from Kaposi's sarcoma. Complications included malnutrition, renal failure, metabolic disorders, and neoplasms.

Conclusions:

• NTM infections in AIDS patients lead to prolonged morbidity, frequent hospital readmissions, and necessitate extended combination treatment.
• Treatment regimens may interact with antiretroviral therapy (ART), requiring careful management and ART adjustments.
• Complex diagnosis underscores the need for comprehensive microbiological and histopathological investigations, especially in the absence of specialized blood cultures.