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 .
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- 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
- SUMMARY AND RECOMMENDATIONS