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Invasive infection with Mycobacterium genavense in three children with the acquired immunodeficiency syndrome
Insights
Severe Mycobacterium genavense infections in children with human immunodeficiency virus present with gastrointestinal issues and anemia. Early detection via microscopy is crucial, as cultures may be negative, guiding multi-drug treatment for better outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Immunology
Background:
- Invasive infections with non-tuberculous mycobacteria (NTM) pose a significant challenge in severely immunocompromised individuals, particularly those with human immunodeficiency virus (HIV).
- Mycobacterium genavense is an emerging opportunistic pathogen that can cause disseminated disease in patients with advanced HIV infection.
Purpose of the Study:
- To report on three pediatric cases of invasive Mycobacterium genavense infection in the context of HIV.
- To highlight the clinical presentation, diagnostic challenges, and potential therapeutic strategies for this rare opportunistic infection.
Main Methods:
- Case series reporting on three children with HIV and invasive M. genavense infection.
- Clinical data collection including symptoms, laboratory findings (CD4 counts, microscopy, cultures), and treatment regimens.
- Microscopic examination of stool samples and lymph node biopsies for acid-fast bacilli.
Main Results:
- Predominant symptoms included fever, abdominal complaints (cramps, distension, diarrhea, ileus), and anemia in severely immunodeficient children (CD4 < 0.04 x 10(9)/l).
- Microscopy revealed numerous acid-fast bacilli in stool and lymph node biopsies, but mycobacterial cultures were consistently negative.
- Two of the three patients showed clinical improvement with multi-drug regimens including amikacin, ethambutol, rifampin, and clarithromycin.
Conclusions:
- Mycobacterium genavense should be considered in the differential diagnosis of invasive non-tuberculous mycobacteriosis in severely immunocompromised children, especially when mycobacterial cultures yield limited growth.
- Diagnostic reliance on microscopy is critical due to potential culture negativity.
- Aggressive multi-drug therapy may be effective in managing invasive M. genavense infections in this vulnerable population.
Abstract:
Three children with human immunodeficiency virus infection and invasive infection with Mycobacterium genavense are reported. Fever spikes, abdominal cramps and distension, diarrhea or ileus, and anemia were the predominant symptoms in the severely immunodeficient patients (CD4 lymphocytes < 0.04 x 10(9)/l). Numerous acid-fast bacilli were readily detectable by microscopy in stool samples and in lymph node biopsies, but cultures for mycobacteria remained negative. Mycobacterium genavense should be sought when invasive non-tuberculous mycobacteriosis is suspected and mycobacterial cultures from blood or other sites show limited growth. Multiple-drug regimens including amikacin, ethambutol, rifampin, and clarithromycin may be of benefit in controlling the infection, as observed in two patients.