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[Coinfection by mycobacteria in HIV-positive patients]
M A von Wichmann1, F Rodríguez-Arrondo, J A Iribarren
1Unidad de Enfermedades Infecciosas, Hospital Nuestra Señora de Aránzazu, Alto de Zorroaga, San Sebastián.
Background:
The aim of this study was to describe the clinical characteristics and therapeutic management of coinfection by mycobacteria in the authors hospital.
Methods:
Two cases of coinfection detected in mixed cultures in agar 7H11 or simultaneous positive cultures in several evaluable clinical samples (blood cultures for MAI and M. kansasii and sputum or stools for M. tuberculosis).
Results:
One coinfection by MAI and M. tuberculosis and another by MAI and M. kansasii in two severely immunosuppressed HIV positive patients with less than 0.010 CD4 lymphocytes/10(9)/l. The clinical manifestations were unspecific, with fever and deterioration of the general state predominating over the 30-45 days of evolution. One of the patients improved with treatment which, in both cases, included a macrolide. Survival was very short and death was by intercurrent causes.
Conclusions:
For the diagnostic of coinfection in severely immunosuppressed patients multiple organic samples should be taken and appropriately processed to detect the mixed cultures or the presence of different mycobacteria in different samples from the same patients. Although the diagnosis of the species is fundamental, the empiric treatment of a disease by mycobacteria in severely immunosuppressed patients should include at least: ethambutol and clarithromycin or azithromycin in addition to other first line tuberculostatic drugs until definitive identification.