Beth Levine, MD; Richard E. Chaisson, MD
Objective: To assess the clinical features and response to therapy of Mycobacterium kansasii infection in patients with human immunodeficiency virus (HIV) infection.
Design: We reviewed the records of all patients with M. kansasii and HIV infection treated between January 1985 and June 1990.
Setting: The Johns Hopkins Hospital, Baltimore, Maryland.
Results: Nineteen patients with M. kansasii and HIV infection were identified; 14 patients had exclusive pulmonary infection, 3 patients had pulmonary and extrapulmonary infection, and 2 patients had exclusive extrapulmonary infection. At the time of diagnosis of M. kansasii infection, the median CD4+ lymphocyte count was 49 cells/µL (range, 0 to 198 cells/µL), and 16 of 19 patients had a previous diagnosis of the acquired immunodeficiency syndrome (AIDS). All 17 patients with pulmonary infection presented with fever and cough of at least 2 weeks duration. Chest radiographs showed either focal upper lobe infiltrates (n = 8) or diffuse interstitial infiltrates (n = 9); 9 patients also had thin-walled cavitary lesions. Nine patients with pulmonary M. kansasii infection were treated with antituberculosis chemotherapy, with resolution of fever and respiratory symptoms, improvement of radiographic infiltrates, and sputum conversion; 1 patient with M. kansasii osteomyelitis also responded to antituberculosis therapy. Autopsies done on 3 treated patients did not reveal any evidence of M. kansasii infection. Nine patients did not receive any antituberculosis chemotherapy; 2 untreated patients developed progressive cavitary pulmonary disease and died from M. kansasii pneumonia.
Conclusions: Mycobacterium kansasii causes serious and potentially life-threatening pulmonary disease in patients with advanced HIV-related immunosuppression. In contrast to previous reports, our findings indicate that disease produced by M. kansasii in patients with HIV infection is responsive to antituberculosis chemotherapy.
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Levine B, Chaisson RE. Mycobacterium kansasii: A Cause of Treatable Pulmonary Disease Associated with Advanced Human Immunodeficiency Virus (HIV) Infection. Ann Intern Med. 1991;114:861–868. doi: 10.7326/0003-4819-114-10-861
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Published: Ann Intern Med. 1991;114(10):861-868.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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