Overview of nontuberculous mycobacteria (excluding MAC) in HIV-infected patients
- Matthew R Leibowitz, MD
Matthew R Leibowitz, MD
- Chief of the Division of Infectious Diseases
- Newton-Wellesley Hospital
- Judith S Currier, MD
Judith S Currier, MD
- Professor of Medicine
- University of California, Los Angeles
Although the majority of disease due to non-tuberculous mycobacteria (NTM) in human immunodeficiency virus (HIV)-infected patients is caused by Mycobacterium avium complex (MAC), other NTM are important pathogens (see "Mycobacterium avium complex (MAC) infections in HIV-infected patients"). Similar to MAC, the risk of disease from other NTM increases with progressive immunodeficiency, with the greatest risk experienced as the CD4 cell count decreases below 50 cells/mm3 .
Prior to the widespread use of combination antiretroviral therapy, HIV-infected patients developed disseminated disease caused by MAC; localized infection with MAC is now more common. By contrast, infection with other NTM can be disseminated or localized. The clinical manifestations vary among the NTM species, and the accurate diagnosis of true infection can be a challenge.
The most commonly isolated NTM species, their clinical manifestations in patients with HIV infection, and recommendations for treatment will be reviewed here. The microbiology, pathogenesis, epidemiology, and clinical manifestations of NTM in patients without HIV are discussed separately. (See "Microbiology of nontuberculous mycobacteria" and "Pathogenesis of nontuberculous mycobacterial infections".)
PRINCIPLES OF DIAGNOSIS AND THERAPY
Diagnosis and therapy of NTM in HIV-infected patients requires a thorough clinical assessment combined with culture data and appropriately directed empiric therapy.
When NTM are isolated from a usually sterile site (eg, blood, bone marrow, lymph nodes, synovial fluid), the diagnosis of true disease is generally straightforward. However, when NTM are isolated from non-sterile sites, such as sputum or bronchoalveolar lavage (BAL) fluid, the diagnosis is less definitive, especially when the colony numbers are low or the isolate is present in only one cultured specimen. A diagnosis of infection then depends upon other clinical findings and the presence or absence of other pathogens. Organisms considered in other circumstances to be commensals can be opportunistic pathogens in patients with advanced HIV disease and immunodeficiency .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Benator DA, Gordin FM. Nontuberculous mycobacteria in patients with human immunodeficiency virus infection. Semin Respir Infect 1996; 11:285.
- Alvarez-Uria G, Falcó V, Martín-Casabona N, et al. Non-tuberculous mycobacteria in the sputum of HIV-infected patients: infection or colonization? Int J STD AIDS 2009; 20:193.
- Richter E, Rüsch-Gerdes S, Niemann S, et al. Detection, identification, and treatment of a novel, non-cultivable Mycobacterium species in an HIV patient. AIDS 2000; 14:1667.
- Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367.
- Jorgensen JH, Salinas JR, Paxson R, et al. False-positive Gen-Probe direct Mycobacterium tuberculosis amplification test results for patients with pulmonary M. kansasii and M. avium infections. J Clin Microbiol 1999; 37:175.
- Lawn SD, Bekker LG, Miller RF. Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis 2005; 5:361.
- Phillips P, Bonner S, Gataric N, et al. Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients: spectrum of disease and long-term follow-up. Clin Infect Dis 2005; 41:1483.
- Phillips DR, Krishnan H, Watson J. First UK report of successful treatment of Mycobacterium simiae and immune reconstitution inflammatory syndrome in an HIV-seropositive patient. Sex Transm Infect 2008; 84:271.
- Horsburgh CR Jr, Selik RM. The epidemiology of disseminated nontuberculous mycobacterial infection in the acquired immunodeficiency syndrome (AIDS). Am Rev Respir Dis 1989; 139:4.
- Good RC, Snider DE Jr. Isolation of nontuberculous mycobacteria in the United States, 1980. J Infect Dis 1982; 146:829.
- Bittner MJ, Horowitz EA, Safranek TJ, Preheim LC. Emergence of Mycobacterium kansasii as the leading mycobacterial pathogen isolated over a 20-year period at a midwestern Veterans Affairs hospital. Clin Infect Dis 1996; 22:1109.
- Campo RE, Campo CE. Mycobacterium kansasii disease in patients infected with human immunodeficiency virus. Clin Infect Dis 1997; 24:1233.
- Pintado V, Gómez-Mampaso E, Martín-Dávila P, et al. Mycobacterium kansasii infection in patients infected with the human immunodeficiency virus. Eur J Clin Microbiol Infect Dis 1999; 18:582.
- Bloch KC, Zwerling L, Pletcher MJ, et al. Incidence and clinical implications of isolation of Mycobacterium kansasii: results of a 5-year, population-based study. Ann Intern Med 1998; 129:698.
- Canueto-Quintero J, Caballero-Granado FJ, Herrero-Romero M, et al. Epidemiological, clinical, and prognostic differences between the diseases caused by Mycobacterium kansasii and Mycobacterium tuberculosis in patients infected with human immunodeficiency virus: a multicenter study. Clin Infect Dis 2003; 37:584.
- Evans AJ, Crisp AJ, Hubbard RB, et al. Pulmonary Mycobacterium kansasii infection: comparison of radiological appearances with pulmonary tuberculosis. Thorax 1996; 51:1243.
- Capdevila O, Zurita A, Domingo E, et al. Multiple cranial osteolytic lesions due to Mycobacterium kansasii in a patient with AIDS. Scand J Infect Dis 1998; 30:305.
- Lillo M, Orengo S, Cernoch P, Harris RL. Pulmonary and disseminated infection due to Mycobacterium kansasii: a decade of experience. Rev Infect Dis 1990; 12:760.
- Tompkins JC, Witzig RS. Mycobacterium kansasii in HIV patients: clarithromycin and antiretroviral effects. Int J Tuberc Lung Dis 2007; 11:331.
- Marras TK, Daley CL. A systematic review of the clinical significance of pulmonary Mycobacterium kansasii isolates in HIV infection. J Acquir Immune Defic Syndr 2004; 36:883.
- Marras TK, Morris A, Gonzalez LC, Daley CL. Mortality prediction in pulmonary Mycobacterium kansasii infection and human immunodeficiency virus. Am J Respir Crit Care Med 2004; 170:793.
- el-Helou P, Rachlis A, Fong I, et al. Mycobacterium xenopi infection in patients with human immunodeficiency virus infection. Clin Infect Dis 1997; 25:206.
- Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med 1997; 156:S1.
- El-Solh AA, Nopper J, Abdul-Khoudoud MR, et al. Clinical and radiographic manifestations of uncommon pulmonary nontuberculous mycobacterial disease in AIDS patients. Chest 1998; 114:138.
- Meybeck A, Fortin C, Abgrall S, et al. Spondylitis due to Mycobacterium xenopi in a human immunodeficiency virus type 1-infected patient: case report and review of the literature. J Clin Microbiol 2005; 43:1465.
- Sobottke R, Zarghooni K, Seifert H, et al. Spondylodiscitis caused by Mycobacterium xenopi. Arch Orthop Trauma Surg 2008; 128:1047.
- Dever LL, Martin JW, Seaworth B, Jorgensen JH. Varied presentations and responses to treatment of infections caused by Mycobacterium haemophilum in patients with AIDS. Clin Infect Dis 1992; 14:1195.
- Straus WL, Ostroff SM, Jernigan DB, et al. Clinical and epidemiologic characteristics of Mycobacterium haemophilum, an emerging pathogen in immunocompromised patients. Ann Intern Med 1994; 120:118.
- Huminer D, Dux S, Samra Z, et al. Mycobacterium simiae infection in Israeli patients with AIDS. Clin Infect Dis 1993; 17:508.
- Al-Abdely HM, Revankar SG, Graybill JR. Disseminated Mycobacterium simiae infection in patients with AIDS. J Infect 2000; 41:143.
- Barzilai A, Rubinovich B, Blank-Porat D, et al. Successful treatment of disseminated Mycobacterium simiae infection in AIDS patients. Scand J Infect Dis 1998; 30:143.
- Fakih M, Chapalamadugu S, Ricart A, et al. Mycobacterium malmoense bacteremia in two AIDS patients. J Clin Microbiol 1996; 34:731.
- Smith MB, Schnadig VJ, Boyars MC, Woods GL. Clinical and pathologic features of Mycobacterium fortuitum infections. An emerging pathogen in patients with AIDS. Am J Clin Pathol 2001; 116:225.
- Wallace RJ Jr, Tanner D, Brennan PJ, Brown BA. Clinical trial of clarithromycin for cutaneous (disseminated) infection due to Mycobacterium chelonae. Ann Intern Med 1993; 119:482.
- Gebo KA, Srinivasan A, Perl TM, et al. Pseudo-outbreak of Mycobacterium fortuitum on a Human Immunodeficiency Virus Ward: transient respiratory tract colonization from a contaminated ice machine. Clin Infect Dis 2002; 35:32.
- Hirschel B, Chang HR, Mach N, et al. Fatal infection with a novel, unidentified mycobacterium in a man with the acquired immunodeficiency syndrome. N Engl J Med 1990; 323:109.
- Tortoli E, Brunello F, Cagni AE, et al. Mycobacterium genavense in AIDS patients, report of 24 cases in Italy and review of the literature. Eur J Epidemiol 1998; 14:219.
- Borde JP, Offensperger WB, Kern WV, Wagner D. Mycobacterium genavense specific mesenteritic syndrome in HIV-infected patients: a new entity of retractile mesenteritis? AIDS 2013; 27:2819.
- Monill JM, Franquet T, Sambeat MA, et al. Mycobacterium genavense infection in AIDS: imaging findings in eight patients. Eur Radiol 2001; 11:193.
- Thomsen VO, Dragsted UB, Bauer J, et al. Disseminated infection with Mycobacterium genavense: a challenge to physicians and mycobacteriologists. J Clin Microbiol 1999; 37:3901.
- Tappe D, Langmann P, Zilly M, et al. Osteomyelitis and skin ulcers caused by Mycobacterium szulgai in an AIDS patient. Scand J Infect Dis 2004; 36:883.
- Hakawi AM, Alrajhi AA. Septic arthritis due to Mycobacterium szulgai in a patient with human immunodeficiency virus: case report. Scand J Infect Dis 2005; 37:235.
- Kang-Birken SL, Prichard JG. Mycobacterium szulgai in a patient with advanced acquired immunodeficiency syndrome: an unusual pathogen with unusual multidrug resistance. Pharmacotherapy 2006; 26:1646.
- PRINCIPLES OF DIAGNOSIS AND THERAPY
- MYCOBACTERIUM KANSASII
- Clinical manifestations
- MYCOBACTERIUM XENOPI
- MYCOBACTERIUM HAEMOPHILUM
- MYCOBACTERIUM SIMIAE
- MYCOBACTERIUM MALMOENSE
- MYCOBACTERIUM FORTUITUM AND MYCOBACTERIUM CHELONAE
- MYCOBACTERIUM GENAVENSE
- MYCOBACTERIUM SZULGAI
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS