Mycobacterium kansasii Among Patients Infected with Human Immunodeficiency Virus in Kansas City

Abstract

Previous reports of infection due to Mycobacterium kansasii among patients infected with human immunodeficiency virus (HIV) have conflicted with regard to the significance of the isolate; the clinical, radiographic, and laboratory features of the disease; and the response to therapy. To clarify the spectrum of M. kansasii infection in this population, we conducted a retrospective study of 35 patients. Twenty-eight of these patients were believed to have disease due to M. kansasii, while the remaining seven patients were probably colonized with the organism. All but two patients presented with advanced HIV infection; the median CD4 cell count was 12/microL. Most patients with pulmonary disease presented with fever, cough, and dyspnea, but only eight of these 22 patients had radiographic findings of either pulmonary cavitation or predominantly upper-lobe disease. Ten patients had M. kansasii isolated from blood or bone marrow. The majority of patients with pulmonary or disseminated disease responded to therapy. However, 11 patients died either before mycobacterial infection was diagnosed or early in the course of treatment, and two had a relapse of infection during therapy.

Clinical Implications of Mycobacterium kansasii Species Heterogeneity: Swiss National Survey

“…It confirms the morbidity and mortality associated with subtype 1 (10) and the role of subtype 2 as an opportunistic pathogen infecting immunosuppressed individuals (27). In HIV-infected patients, M. kansasii is generally identified at the stage of advanced immunodeficiency (mean CD4-positive cell count, Ͻ100 cells/mm 3 ) (3,4,6,28). In contrast, clinical infection with other subtypes appears to be exceptional, and the isolation of these subtypes from patients with underlying pulmonary disease suggests that they act as colonizing agents or environmental contaminants.…”

Mycobacterium kansasii: antibiotic susceptibility and PCR-restriction analysis of clinical isolates

“…The American Thoracic Society (ATS) guidelines from 1990 required at least two positive respiratory samples for the diagnosis of pulmonary infection (American Thoracic Society, 1990). However, the isolation of M. kansasii from respiratory sites appears to correlate well with pulmonary disease in those with HIV infection (Bamberger et al, 1994;Wolinsky, 1981), which led the ATS to modify its recommendation in 1997 (American Thoracic Society, 1997).…”

Epidemiological, Clinical, and Prognostic Differences between the Diseases Caused by Mycobacterium kansasii and Mycobacterium tuberculosis in Patients Infected with Human Immunodeficiency Virus: A Multicenter Study

“…Although evidence of pleural effusions was more frequent in the M. kansasii group, the organism was not isolated from any of the pleural effusion samples, and other concomitant processes could cause it. The presence of pleural effusions in patients with pulmonary disease caused by M. kansasii (with or without coinfection with HIV) has rarely been described by other authors [16,19,36].…”