mycobacteriosis, the hiv epidemic, and minority patients.

NLM AIDSLINE Mycobacteriosis, the HIV epidemic, and minority patients. Rosario AT; Peters B; Afessa B; Green W; Greaves W; Frederick W; Howard
January 30, 1997

Int Conf AIDS. 1996 Jul 7-12;11(2):24 (abstract no. We.B.302). Unique Objective: To describe the characteristics of mycobacterial infection among inner city hospital patients between 1986 -1995. Methods: We reviewed records from the mycobacteriology laboratory and autopsy files of all patients with mycobacterial infection based on positive Fite or Ziehl-Neelsen stains, culture or both. Results: A total of 805 patients was identified on the basis of a positive stain, culture or both; 554 were men(68.8%) and 251 women(31.2%) with a median age of 43.5 years. There were 780 blacks, 11 caucasians, 11 hispanics and 3 indians. Of these, 449(55.8%) were seropositive, 151 seronegative and 205 of unknown HIV status. Species identification was possible for isolates from 710 patients(88.2%). M. avium complex (MAC) accounted for 290, M. tuberculosis (MTb) for 250, M. kansasi (MK) for 96, M. fortuitum MF) 28, M. chelonei (MC) 13 and others 33. A total of 51 patients had specimens that yielded no growth despite positive smears. The annual incidence rate of mycobacteriosis remained fairly uniform until 1993 when an upward trend began but is now levelling off. Between 1986-92 MTb was the predominant mycobacterial species isolated annually but MAC surpassed MTb as the predominant organism isolated from patients between 1993-95. Mycobacteria were more commonly isolated from sputum 58%(467), blood 11.4%(92) and broncho-alveolar lavage specimens 9.7%(78). Of 202 MTb isolates tested, 12.4% were resistant to INH, 7.2% were resistant to rifampin and 8.4% to ethambutol. The most common mycobacterial species identified among HIV seropositive patients were MAC (247), MTb and MK each from 61 patients, versus MTb (90), MK(16) and MAC(12) among HIV seronegative patients. Clinical specimens from 5 patients, all HIV seropositive,revealed concomitant infection with two species of mycobacteria. Mycobacteria (8 MTb, 2 MK) were isolated from cerebrospinal fluid in 10 patients, five of whom were HIV seropositive. Conclusions: In contrast to the recent experience at other institutions serving minority inner city patients we did not observe an increasing trend for MTb in general or among HIV seropositive patients. We also did not find an increase in multidrug resistant MTb strains. HIV Infections/COMPLICATIONS Mycobacterium/ISOLATION & PURIF *Mycobacterium Infections/EPIDEMIOLOGY

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Information in this article was accurate in January 30, 1997. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.