Disseminated Mycobacterium avium complex (MAC): Correlation between blood cultures and tissue burden in AIDS patients.

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Disseminated Mycobacterium avium complex (MAC): Correlation between blood cultures and tissue burden in AIDS patients.

Natl Conf Hum Retroviruses Relat Infect (2nd). 1995 Jan 29-Feb 2;:75. Unique Identifier : AIDSLINE AIDS/95920147
Torriani F; Behling C; McCutchan JA; Haubrich R; Keays L; Havlir D; University of California, San Diego, CA.

Abstract: BACKGROUND: MAC quantitative blood cultures are used to evaluate therapeutic response, but the relationship of this measurement to tissue burden is not known. To determine the relationship between quantitative MAC cultures in blood and tissues and the influence of therapy, we prospectively correlated histopathology and MAC colony forming units (CFU) in tissue and blood in autopsied patients with MAC bacteremia. METHODS: At autopsy both blood and tissue systematically collected from spleen, liver, lymph nodes, bone marrow, ileum, colon and myocardium were assayed for MAC CFU. The organs were assessed for presence of acid-fast bacilli, foamy histiocytes and granulomas. RESULTS: Seven patients treated with a regimen including clarithromycin were examined. Mead CFU/ml in blood was 1.6+/-3.1x10(3) (range:0-7.8x10(3)). Two patients had negative blood and tissue cultures at autopsy. The reticuloendothelial (RE) tissues demonstrated the highest mean CFU/gram: 1.9x10(6)(0- 9x10(6)) in lymph nodes, 0.87x10(6)(0-5.2x10(6) in spleen, 0.51x10(6)) in liver (0-3.3x10(6)). The gastrointestinal system had considerably lower counts with a mean of 21x10(3) in the colon and 11x10(3) in the ileum, followed by the bone marrow with 9x10(3). There was a significant correlation between quantitative blood and RE tissues CFU (r=0.99,p less than 0.001). Histologic involvement of the RE organs correlated with quantitative tissue cultures (p=0.008). CONCLUSION: These results suggest the degree of circulating MAC and tissue involvement are highly correlated and that treatment of MAC bacteremia when CFU are low may lead to total sterilization of tissues in some patients.

Keywords: Autopsy AIDS-Related Opportunistic Infections/BLOOD/DRUG THERAPY/ *MICROBIOLOGY Bacteremia Clarithromycin/THERAPEUTIC USE Human Mycobacterium avium-intracellulare Infection/BLOOD/DRUG THERAPY/ *MICROBIOLOGY Prospective Studies ABSTRACT
951230
M95C2990

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