Chest
Volume 114, Issue 1, July 1998, Pages 138-145
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Clinical Investigations
Clinical and Radiographic Manifestations of Uncommon Pulmonary Nontuberculous Mycobacterial Disease in AIDS Patients

https://doi.org/10.1378/chest.114.1.138Get rights and content

Study objective

To determine the clinical and radiographic findings of nontuberculous mycobacteria (NTM) other than Mycobacterium avium complex (MAC) and Mycobacterium kansasii in AIDS compared with non-AIDS patients.

Design

A retrospective chart review of all patients in whom NTM other than MAC complex and M kansasii were isolated between April 1, 1989, and October 31, 1995.

Setting

University-affiliated hospital.

Patients

Fifty-four patients met the criteria for uncommon pulmonary NTM disease: (1) repeated isolation of atypical mycobacterium in colony counts of ≥3 from two or more sputum specimens; or isolation of the organism from transbronchial or open lung biopsy specimen with histologic changes suggestive of mycobacterial disease in the absence of other pathogens; and (2) either an abnormal chest radiograph, the cause of which had not been attributed to an active infection other than atypical mycobacterial disease; or the presence of one or more symptoms indicative of pulmonary disease coupled with exclusion of other illnesses with similar symptoms and signs.

Results

Thirty-five patients were HIV positive. Fever was the only clinical symptom more commonly seen in HIV-infected patients with NTM than non-HIV-infected patients. Sixty-six percent of all patients with AIDS were infected by Mycobacterium xenopi. Chest radiographs of AIDS patients showed a tendency for predominance of interstitial infiltrate and rarity of fibronodular disease. No specific radiographic pattern was observed for any particular organism. Adenopathy was not a feature of uncommon pulmonary NTM in AIDS, and it should suggest an alternate diagnosis. In two patients, NTM isolation from respiratory specimens preceded dissemination. Six of 8 AIDS patients treated for pulmonary NTM remained alive at the end of the study compared with only 4 of 15 patients who were not treated for pulmonary NTM (p<0.05).

Conclusions

Uncommon NTM isolated from respiratory specimens ought to be considered as serious pathogens in the presence of clinical and radiographic manifestations unexplained by other pathologic processes. Colonization with NTM could precede dissemination. Treatment of uncommon pulmonary NTM disease could possibly confer a survival benefit in AIDS patients.

Section snippets

Study Design

This study was conducted at the Erie County Medical Center, a 479-bed tertiary care teaching institution, affiliated with the State University of New York at Buffalo. The hospital has the largest tuberculosis clinic in Erie County and the major AIDS treatment center in the region. All mycobacterial isolates from this area are referred to the mycobacteriology laboratory at the Erie County Medical Center for final identification.

All patients with positive cultures for NTM other than MAC and M

Patient Population

One hundred sixty-eight patients were identified from the mycobacteriologic records. Fifty-four patients met the inclusion criteria for uncommon NTM disease. Fifty-one of the 54 patients included in the study were seen in the emergency department or ambulatory care clinic and were admitted to the hospital for respiratory complaints or abnormal chest radiographs suspicious for active pulmonary tuberculosis. During their hospital stay, all of the 51 patients on whom acid-fast bacilli sputum

Discussion

To our knowledge, this study is the first comprehensive description of the clinical and radiographic features of pulmonary NTM disease other than MAC or M kansasii in AIDS patients. Previous reports of NTM disease in the AIDS population were limited to anecdotal cases of disseminated NTM disease. The recognition of the pathogenecity of these microorganisms was limited by the difficulty in associating clinical disease to positive cultures, frequent coexistent pathogens, and lack of established

Addendum

Since the submission of this manuscript, the American Thoracic Society has issued revised criteria for the diagnosis of NTM.26 These criteria were developed to fit best for MAC, Mycobacterium abscessus, and M kansasii. As the authors themselves state, the applicability of the definition for other NTM is uncertain. The operational definitions of NTM lung used in our article encompass only the uncommon NTM disease as an investigational tool and differs in purpose and intent from the August 1997

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