Non-tuberculous mycobacteria in the sputum of HIV-infected patients: infection or colonization?

Alvarez-Uria, Gerardo; Falcó, Vicenç; Martín-Casabona, N; Crespo, Manel; Saz, Sara Villar del; Curran, Adrían; Ocaña, I; Ribera, Esteban; Pahissa, Albert

doi:10.1258/ijsa.2008.008300

Cited by 10 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…kansasii is considered one of the most virulent NTM, and observational studies have reported variable mortality rates. 9,10 The clinical presentation is similar to that of M. tuberculosis, [9][10][11] with symptoms of fever and cough usually lasting more than 30 days, [10][11][12][13][14] which is considerably longer than in our patient. After initiation of HAART, the deterioration in his general condition could have occurred for several reasons, one of them being IRIS.…”

Section: Discussionsupporting

confidence: 58%

Isoniazid-resistant Mycobacterium kansasii in an HIV-positive patient, and possible development of immune reconstitution inflammatory syndrome after initiation of highly active antiretroviral therapy: case report

Despotović¹,

Savić

Salemović³

et al. 2016

International Journal of Infectious Diseases

View full text Add to dashboard Cite

Non-tuberculous mycobacteria are rare but important causes of infection in HIV-positive individuals. A 28-year-old HIV-positive male presented with a high fever, non-productive cough, right subcostal pain, splenomegaly, a very low CD4 count, elevated C-reactive protein and erythrocyte sedimentation rate, and a normal white blood cell count. The suspicion of tuberculosis (TB) was very high, and sputum samples were positive for acid-fast bacilli. Standard quadruple anti-TB therapy was initiated, but once culture of the sample revealed Mycobacterium kansasii, pyrazinamide was withdrawn. Highly active antiretroviral therapy (HAART) was initiated soon after, consisting of abacavir/lamivudine and efavirenz. The patient's general condition deteriorated 2 weeks after HAART initiation, which could have been due to the development of immune reconstitution inflammatory syndrome (IRIS). The patient recovered and was discharged in good condition. However, the results of resistance testing of the isolated organism arrived after discharge, and showed isoniazid and streptomycin resistance. This is the first case report of M. kansasii infection from Serbia and shows the difficulties encountered during the course of treatment.

show abstract

Section: Discussionsupporting

confidence: 58%

Isoniazid-resistant Mycobacterium kansasii in an HIV-positive patient, and possible development of immune reconstitution inflammatory syndrome after initiation of highly active antiretroviral therapy: case report

Despotović¹,

Savić

Salemović³

et al. 2016

International Journal of Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…However, when it is isolated from non-sterile sites, such as the respiratory or GI tract, the diagnosis can be less definitive. A case series from Spain, conducted between 1998 and 2005, identified 26 HIV-infected patients with NTM isolates from sputum 10. As in our patient, they used clinical criteria to establish a diagnosis of colonisation versus infection; some of the factors associated with disease were CD4+ T-cell count <50/µL, weight loss, haemoglobin <11 g/dL and duration of symptoms longer than a month.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Kaposi sarcoma and disseminatedMycobacterium genavenseinfection in an HIV-infected patient

Tribuna¹,

Cristina

Eira

et al. 2015

BMJ Case Reports

View full text Add to dashboard Cite

We report a case of Kaposi sarcoma (KS) and disseminated infection by Mycobacterium genavense in a 40-year-old HIV-positive man with CD4+ T-cell count 5/µL. He presented with anorexia, diarrhoea, cachexia and multiple firm violaceous nodules distributed over the face, neck and upper and lower extremities. Biopsy of a skin nodule was performed, confirming KS. Immunoperoxidase staining for human herpesvirus 8 was strongly positive. Endoscopic examination revealed erosive duodenopathy. Multiple biopsy samples showed numerous acid-fast bacilli at direct microscopic examination. Real-time PCR (RT-PCR) identified M. genavense. A CT scan showed diffuse pulmonary inﬁltrates with a 'tree-in-bud' appearance, striking splenomegaly and abdominal lymphadenopathy. A bronchoscopy was performed, revealing typical Kaposi's lesions in the upper respiratory tract. RT-PCR of bronchial aspirate identified M. genavense and Pneumocystis jirovecii. Despite treatment with highly active antiretroviral therapy, antimycobacterial therapy and trimethoprim/sulfamethoxazole, the outcome was fatal.

show abstract

“…Although pooled specificity of urine LAM was relatively high (Ն96%), specificity was found to be low (84% to 94%) in several studies and even lower in studies of serum and sputum LAM. Possible reasons include the presence of latent TB infection, misclassification of subclinical TB cases, or cross-reactivity with nontuberculous mycobacteria (3,28,30,36). Studies are now required to clarify the cause of reduced LAM specificity.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Antigen Detection Tests for the Diagnosis of Tuberculosis

Flores

Steingart

Dendukuri

et al. 2011

Clin Vaccine Immunol

View full text Add to dashboard Cite

Tests that detect Mycobacterium tuberculosis antigens in clinical specimens could provide rapid direct evidence of active disease. We performed a systematic review to assess the diagnostic accuracy of antigen detection tests for active tuberculosis (TB) according to standard methods and summarized test performance using bivariate random effects meta-analysis. Overall, study quality was a concern. For pulmonary TB (47 studies, 5,036 participants), sensitivity estimates ranged from 2% to 100% and specificity from 33% to 100%. Lipoarabinomannan (LAM) was the antigen most frequently targeted (23 studies, 49%). The pooled sensitivity of urine LAM was higher in HIV-infected than HIV-uninfected individuals (47%; 95% confidence interval [CI], 26 to 68% versus 14%; 95% CI, 4 to 38%); pooled specificity estimates were similar: 96%; 95% CI, 81 to 100% and 97%; 95% CI, 86 to 100%, respectively. For extrapulmonary TB (21 studies, 1,616 participants), sensitivity estimates ranged from 0% to 100% and specificity estimates from 62% to 100%. Five studies targeting LAM, ESAT-6, Ag85 complex, and the 65-kDa antigen in cerebrospinal fluid, when pooled, yielded the highest sensitivity (87%; 95% CI, 61 to 98%), but low specificity (84%; 95% CI, 60 to 95%). Because of the limited number of studies targeting any specific antigen other than LAM, we could not draw firm conclusions about the overall clinical usefulness of these tests. Further studies are warranted to determine the value of LAM detection for TB meningitis in high-HIV-prevalence settings. Considering that antigen detection tests could be translated into rapid point-of-care tests, research to improve their performance is urgently needed.The World Health Organization (WHO) estimates that in 2009, 9.4 million new cases of tuberculosis (TB) occurred and 1.7 million people died of the disease (89). The vast majority of these patients live in low-and middle-income countries (LMIC) where TB diagnosis depends primarily on smear microscopy. Microscopy has low sensitivity and does not detect smear-negative TB (77), which may account for 24% to 61% of all pulmonary cases in HIV-infected individuals (27). Improved diagnostic tests, such as mycobacterial culture and nucleic acid amplification (NAA) tests, are available in highincome countries but are often too expensive and complex for routine use by TB control programs in resource-constrained settings in which TB is endemic. Lack of access to diagnostic services in resource-limited settings presents an additional barrier to using these tests. The Xpert MTB/RIF (Cepheid, Inc., Sunnyvale, CA), recently endorsed by the WHO, is rapid and highly sensitive for detection of TB and drug resistance; however, this new technology is costly, preventing its use in many areas where the epidemic is most severe (10). Accurate, rapid, inexpensive, and simple diagnostic tests are urgently needed for TB care and control.There have been considerable efforts over the past 50 years to devise a rapid TB test based on antibody detection. However, substantial ...

show abstract

Non-tuberculous mycobacteria in the sputum of HIV-infected patients: infection or colonization?

Cited by 10 publications

References 13 publications

Isoniazid-resistant Mycobacterium kansasii in an HIV-positive patient, and possible development of immune reconstitution inflammatory syndrome after initiation of highly active antiretroviral therapy: case report

Isoniazid-resistant Mycobacterium kansasii in an HIV-positive patient, and possible development of immune reconstitution inflammatory syndrome after initiation of highly active antiretroviral therapy: case report

Pulmonary Kaposi sarcoma and disseminatedMycobacterium genavenseinfection in an HIV-infected patient

Systematic Review and Meta-Analysis of Antigen Detection Tests for the Diagnosis of Tuberculosis

Contact Info

Product

Resources

About