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Clinical and Epidemiologic Features of Infection With Mycobacterium genavense

Clinical and Epidemiologic Features of Infection With Mycobacterium genavense Abstract Objectives: To characterize clinical and epidemiologic features of infections with Mycobacterium genavense. Design: Case series and case-control studies. Patients with M genavense were compared with two control groups: CD4 controls were matched on the basis of CD4 counts, and Mycobacterium avium-intracellularecomplex controls had disseminated infection with M avium-intracellulare complex. Results: Fifty-four patients with disseminated infections caused by M genavense were found, from Europe (37), North America (15), and Australia (two). All were infected with human immunodeficiency virus. The median CD4 count was 0.016× 109/L (16/mm3) (range, 0.001 to 0.082×109/L. Eighty-seven percent had fever and weight loss, 44% had diarrhea, 43% had splenomegaly, 39% had hepatomegaly, and 72% had anemia. In Swiss university hospitals, M genavense was responsible for 12.8% of nontuberculous disseminated mycobacterial infections in patients with human immunodeficiency virus from 1990 to 1992. The median survival was 190 days after the first isolation of M genavense. Among the patients who had been treated with at least two antimycobacterial drugs for 1 month or more, median survival was 263 days (95% confidence interval, 144 to 382 days), compared with 81 days (95% confidence interval, 73 to 89 days) for those not treated (P=.0009). Survival in patients with M genavense was similar to the survival of M avium-intracellulare complex controls. However, patients with similar CD4 counts (CD4 controls) survived longer (median, 342 days; 95% confidence interval, 269 to 415 days; P<.0003). Conclusions: Infection with M genavense may be responsible for more than 10% of disseminated nontuberculous mycobacterial infections in patients with human immunodeficiency virus infection. Its clinical presentation and response to treatment are similar to those of infection with M avium-intracellulare complex.(Arch Intern Med. 1995;155:400-404) References 1. Horsburgh CR Jr. Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. N Engl J Med . 1991;324:1332-1338.Crossref 2. Nightingale SD, Byrd LT, Southern PM, Jockusch JD, Cal SX, Wynne BA. Incidence of Mycobacterium avium-intracellulare complex bacteremia in human immunodeficiency virus—positive patients. J Infect Dis . 1992;165: 1082-1085.Crossref 3. Horsburgh CR Jr, Selik RM. The epidemiology of disseminated nontuberculous mycobacterial infection in the acquired immunodeficiency syndrome (AIDS). Am Rev Respir Dis . 1989;139:4-7.Crossref 4. Böttger EC, Hirschel B, Coyle MB. Mycobacterium genavense sp. nov. Int J Syst Bacteriol . 1993;43:841-843.Crossref 5. Coyle MB, Carlson LC, Wallis CK, et al. Laboratory aspects of 'Mycobacterium genavense,' a proposed species isolated from AIDS patients. J Clin Microbiol . 1992;30:3206-3212. 6. Hirschel B, Chang HR, Mach N, et al. Fatal infection with a novel unidentified mycobacterium in a man with the acquired immunodeficiency syndrome. N Engl J Med . 1990;323:109-113.Crossref 7. Rogall T, Wolters J, Flohr T, Böttger EC. Towards a phylogeny and definition of species at the molecular level within the genus Mycobacterium. Int J Syst Bacteriol . 1990;40:323-330.Crossref 8. Böttger EC, Teske A, Kirschner P, et al. Disseminated 'Mycobacterium genavense' infection in patients with AIDS. Lancet . 1992;340:76-80.Crossref 9. Wald A, Coyle MB, Carlson LC, ThomHooton,ton TM. Infection with a fastidious mycobacterium resembling Mycobacterium simiae in seven patients with AIDS. Ann Intern Med . 1992;117:586-589.Crossref 10. Jackson K, Sievers A, Ross BC, [ill] B. Isolation of a fastidious Mycobacterium species from two AIDS patients. J Clin Microbiol . 1992;30:2934-2937. 11. Bessesen MT, Shlay J, Stone-Venohr B, Cohn DL, Reves RR. Disseminated Mycobacterium genavense infection: clinical and microbiological features and response to therapy. AIDS . 1993;7:1357-1361.Crossref 12. Nadal D, Caduff R, Kraft R, et al. Invasive infection with Mycobacterium genavense in three children with the acquired immunodeficiency syndrome. Eur J Clin Microbiol Infect Dis . 1993;12:37-43.Crossref 13. Gaynor CD, Clark RA, Koontz FP, Emler S, Hirschel B, Schlesinger S. Mycobacterium genavense: disseminated infection in two patients with AIDS. Clin Infect Dis . 1994;18:455-457.Crossref 14. Tortoli E, Simonetti T, Dionisio D, Meli M. Cultural studies on two isolates of 'Mycobacterium genavense' from patients with AIDS. Diagn Microbiol Infect Dis . 1994;18:7-12.Crossref 15. Centers for Disease Control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR Morb Mortal Wkly Rep . 1987;36:3S-15S. 16. Ward DM, Weller R, Bateson MM. 16S rRNA sequences reveal numerous uncultured microorganisms in a natural community. Nature . 1990;345:63-65.Crossref 17. Edwards U, Rogall T, Blöcker H, Emde M, Böttger EC. Isolation and direct complete nucleotide determination of entire genes: characterization of a gene coding for 16S ribosomal RNA. Nucleic Acids Res . 1987;17:7843-7853.Crossref 18. Böddinghaus B, Rogall T, Flohr T, Böttger EC, Blöcker H. Detection and identification of mycobacteria by amplification of rRNA. J Clin Microbiol . 1990;28:1751-1759. 19. Heald A, Flepp M, Chave JP, et al. Treatment for cerebral toxoplasmosis protects against Pneumocystis carinii pneumonia in patients with AIDS: the Swiss HIV Cohort Study. Ann Intern Med . 1991;115:760-763.Crossref 20. Rothman KJ: Modern Epidemiology . Boston, Mass: Little Brown & Co; 1986. 21. Hoop RK, Bottger EC, Ossent P, Salfinger M. Mycobacteriosis due to Mycobacterium genavense in six pet birds. J Clin Microbiol . 1993;31:990-993. 22. Horsburgh CR Jr, Havlik JA, Ellis DA, et al. Survival of patients with acquired immune deficiency syndrome and disseminated Mycobacterium avium complex infection with and without antimycobacterial chemotherapy. Am Rev Respir Dis . 1991;144:557-559.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430040074009
Publisher site
See Article on Publisher Site

Abstract

Abstract Objectives: To characterize clinical and epidemiologic features of infections with Mycobacterium genavense. Design: Case series and case-control studies. Patients with M genavense were compared with two control groups: CD4 controls were matched on the basis of CD4 counts, and Mycobacterium avium-intracellularecomplex controls had disseminated infection with M avium-intracellulare complex. Results: Fifty-four patients with disseminated infections caused by M genavense were found, from Europe (37), North America (15), and Australia (two). All were infected with human immunodeficiency virus. The median CD4 count was 0.016× 109/L (16/mm3) (range, 0.001 to 0.082×109/L. Eighty-seven percent had fever and weight loss, 44% had diarrhea, 43% had splenomegaly, 39% had hepatomegaly, and 72% had anemia. In Swiss university hospitals, M genavense was responsible for 12.8% of nontuberculous disseminated mycobacterial infections in patients with human immunodeficiency virus from 1990 to 1992. The median survival was 190 days after the first isolation of M genavense. Among the patients who had been treated with at least two antimycobacterial drugs for 1 month or more, median survival was 263 days (95% confidence interval, 144 to 382 days), compared with 81 days (95% confidence interval, 73 to 89 days) for those not treated (P=.0009). Survival in patients with M genavense was similar to the survival of M avium-intracellulare complex controls. However, patients with similar CD4 counts (CD4 controls) survived longer (median, 342 days; 95% confidence interval, 269 to 415 days; P<.0003). Conclusions: Infection with M genavense may be responsible for more than 10% of disseminated nontuberculous mycobacterial infections in patients with human immunodeficiency virus infection. Its clinical presentation and response to treatment are similar to those of infection with M avium-intracellulare complex.(Arch Intern Med. 1995;155:400-404) References 1. Horsburgh CR Jr. Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. N Engl J Med . 1991;324:1332-1338.Crossref 2. Nightingale SD, Byrd LT, Southern PM, Jockusch JD, Cal SX, Wynne BA. Incidence of Mycobacterium avium-intracellulare complex bacteremia in human immunodeficiency virus—positive patients. J Infect Dis . 1992;165: 1082-1085.Crossref 3. Horsburgh CR Jr, Selik RM. The epidemiology of disseminated nontuberculous mycobacterial infection in the acquired immunodeficiency syndrome (AIDS). Am Rev Respir Dis . 1989;139:4-7.Crossref 4. Böttger EC, Hirschel B, Coyle MB. Mycobacterium genavense sp. nov. Int J Syst Bacteriol . 1993;43:841-843.Crossref 5. Coyle MB, Carlson LC, Wallis CK, et al. Laboratory aspects of 'Mycobacterium genavense,' a proposed species isolated from AIDS patients. J Clin Microbiol . 1992;30:3206-3212. 6. Hirschel B, Chang HR, Mach N, et al. Fatal infection with a novel unidentified mycobacterium in a man with the acquired immunodeficiency syndrome. N Engl J Med . 1990;323:109-113.Crossref 7. Rogall T, Wolters J, Flohr T, Böttger EC. Towards a phylogeny and definition of species at the molecular level within the genus Mycobacterium. Int J Syst Bacteriol . 1990;40:323-330.Crossref 8. Böttger EC, Teske A, Kirschner P, et al. Disseminated 'Mycobacterium genavense' infection in patients with AIDS. Lancet . 1992;340:76-80.Crossref 9. Wald A, Coyle MB, Carlson LC, ThomHooton,ton TM. Infection with a fastidious mycobacterium resembling Mycobacterium simiae in seven patients with AIDS. Ann Intern Med . 1992;117:586-589.Crossref 10. Jackson K, Sievers A, Ross BC, [ill] B. Isolation of a fastidious Mycobacterium species from two AIDS patients. J Clin Microbiol . 1992;30:2934-2937. 11. Bessesen MT, Shlay J, Stone-Venohr B, Cohn DL, Reves RR. Disseminated Mycobacterium genavense infection: clinical and microbiological features and response to therapy. AIDS . 1993;7:1357-1361.Crossref 12. Nadal D, Caduff R, Kraft R, et al. Invasive infection with Mycobacterium genavense in three children with the acquired immunodeficiency syndrome. Eur J Clin Microbiol Infect Dis . 1993;12:37-43.Crossref 13. Gaynor CD, Clark RA, Koontz FP, Emler S, Hirschel B, Schlesinger S. Mycobacterium genavense: disseminated infection in two patients with AIDS. Clin Infect Dis . 1994;18:455-457.Crossref 14. Tortoli E, Simonetti T, Dionisio D, Meli M. Cultural studies on two isolates of 'Mycobacterium genavense' from patients with AIDS. Diagn Microbiol Infect Dis . 1994;18:7-12.Crossref 15. Centers for Disease Control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR Morb Mortal Wkly Rep . 1987;36:3S-15S. 16. Ward DM, Weller R, Bateson MM. 16S rRNA sequences reveal numerous uncultured microorganisms in a natural community. Nature . 1990;345:63-65.Crossref 17. Edwards U, Rogall T, Blöcker H, Emde M, Böttger EC. Isolation and direct complete nucleotide determination of entire genes: characterization of a gene coding for 16S ribosomal RNA. Nucleic Acids Res . 1987;17:7843-7853.Crossref 18. Böddinghaus B, Rogall T, Flohr T, Böttger EC, Blöcker H. Detection and identification of mycobacteria by amplification of rRNA. J Clin Microbiol . 1990;28:1751-1759. 19. Heald A, Flepp M, Chave JP, et al. Treatment for cerebral toxoplasmosis protects against Pneumocystis carinii pneumonia in patients with AIDS: the Swiss HIV Cohort Study. Ann Intern Med . 1991;115:760-763.Crossref 20. Rothman KJ: Modern Epidemiology . Boston, Mass: Little Brown & Co; 1986. 21. Hoop RK, Bottger EC, Ossent P, Salfinger M. Mycobacteriosis due to Mycobacterium genavense in six pet birds. J Clin Microbiol . 1993;31:990-993. 22. Horsburgh CR Jr, Havlik JA, Ellis DA, et al. Survival of patients with acquired immune deficiency syndrome and disseminated Mycobacterium avium complex infection with and without antimycobacterial chemotherapy. Am Rev Respir Dis . 1991;144:557-559.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 27, 1995

References