Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
MYCOBACTERIAL DISEASES
Infect Dis Ther; 3:253-64 1989. Unique Identifier : AIDSLINE ICDB/90665449 Schecter GF; Bureau of Communicable Disease Control, Dept. of Public Health,; San Francisco, CA
Abstract:
Infection with Mycobacterium avium complex (MAC) was found in some of the earliest reported AIDS cases. In these patients (pts) the manifestations of MAC infection were radically different from those of the previously known chronic pulmonary disease found in pts with pre-existing lung disease. Epidemiology, pathophysiology, clinical findings, diagnosis, and treatment are reviewed for M tuberculosis and MAC. Prevention of M tuberculosis and other mycobacterial infections reported in pts with AIDS is also discussed. Diagnosis of tuberculosis in pts with AIDS can be difficult. The tuberculin skin test is reactive in only about 10-39% of pts with AIDS in contrast to over 90% positive in tuberculosis pts without AIDS. Although a number of regimens have proven effective in the treatment of tuberculosis, currently there are two that are recommended by the Centers for Disease Control and American Thoracic Society. The first is a 6-mo regimen of isoniazid (INH) at 300 mg/day and rifampicin at 600 mg/day, with the addition of pyrazinamide at 20-30 mg/kg day for the initial 2 mo of treatment. The second recommended regimen is a 9-mo regimen of INH and rifampicin in the same dosages. The addition of ethambutol or streptomycin to either regimen at the outset of treatment pending results of sensitivity tests is optional. Mortality in pts with tuberculosis and AIDS is high. Survival for pts with AIDS and tuberculosis from the time of either the tuberculosis diagnosis or the AIDS diagnosis tends to follow the same general time course as survival after diagnosis of Pneumocystis carinii pneumonia and is shorter than for pts in whom Kaposi's sarcoma is the sole initial manifestation of AIDS. Because of the progressive immunosuppression resulting from HIV infection, pts with quiescent M tuberculosis infection are at a very high risk of reactivation if they become superinfected with HIV. MAC (or Mycobacterium avium-intracellulare) occurs widely in nature, being endemic in waterfowl and commonly present in soil and water. MAC infection is difficult to treat in the nonimmunocompromised host. Various 4-, 5-, and 6-drug regimens, usually including INH, rifampicin, ethambutol, and streptomycin, with or without cycloserine and ethionamide, have been given for 18-24 mo to pts with chronic pulmonary cases, resulting in cure rates of 50-75%. Adjunctive surgery for localized cavitary lung disease has resulted in a somewhat higher response rate. In pts with AIDS, the response to treatment usually has been minimal. (29 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DIAGNOSIS Human Mycobacterium avium-intracellulare Infection/*COMPLICATIONS/ DIAGNOSIS Opportunistic Infections/*COMPLICATIONS/DIAGNOSIS Risk Factors Tuberculosis, Pulmonary/*COMPLICATIONS/DIAGNOSIS JOURNAL ARTICLE REVIEW, TUTORIAL REVIEW 901030
M90A0687
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
