Disseminated disease due to non-tuberculous mycobacteria in HIV positive patients: A retrospective case control study

Abstract

Introduction Disseminated infection due to non-tuberculous mycobacteria has been a major factor of mortality and comorbidity in HIV patients. Until 2018, U.S. American guidelines have recommended antimycobacterial prophylaxis in patients with low CD4 cell counts, a practice that has not been adopted in Europe. This study aimed at examining the impact of disseminated NTM disease on clinical outcome in German HIV patients with a severe immunodeficiency. Materials and methods In this retrospective case control study, HIV patients with disseminated NTM disease were identified by retrospective chart review and matched by their CD4 cell counts to HIV patients without NTM infection in a 1:1 alocation. Primary endpoints were mortality and time to first rehospitalisation. In addition, other opportunistic diseases, as well as antimycobacterial and antiretroviral treatments were examined. Results Between 2006 and 2016, we identified 37 HIV patients with disseminated NTM disease. Most of them were suffering from infections due to M. avium complex (n = 31, 77.5%). Time to event analysis showed a non-significant trend to higher mortality in patients with disseminated NTM disease (p = 0.24). Rehospitalisation took place significantly earlier in patients with disseminated NTM infections (median 40.5 days vs. 109 days, p<0.0001). Conclusion In this retrospective case control study, we could demonstrate that mortality is not significantly higher in HIV patients with disseminated NTM disease in the ART era, but that they require specialised medical attention in the first months following discharge.

Disseminated Mycobacterium peregrinum and Mycobacterium avium infection in a patient with AIDS: A case report and review of literature

“…There are four main clinical syndromes: pulmonary infection, skin and soft tissue infection, lymphadenitis, and disseminated infection. Though there is no clear-cut definition for disseminated NTM infection, a consensus seems to be reached among most literatures that disseminated NTM infection is defined as isolation of NTM from blood or bone marrow [12] , [13] , [14] . Some literature also included isolation of NTM from liver biopsy or from ≥ 2 noncontiguous organs as disseminated infection [13] , [14] , [15] .…”

“…Though there is no clear-cut definition for disseminated NTM infection, a consensus seems to be reached among most literatures that disseminated NTM infection is defined as isolation of NTM from blood or bone marrow [12] , [13] , [14] . Some literature also included isolation of NTM from liver biopsy or from ≥ 2 noncontiguous organs as disseminated infection [13] , [14] , [15] . Disseminated NTM infections are mainly found in patients with immunodeficiency, such as AIDS and leukemia/lymphoma, and in those with genetic defects or mutations (for examples, Mendelian susceptibility to mycobacterial disease, nuclear factor κB essential modulator mutation, signal transducer and activator of transcription 1 deficiency) or presence of anti-interferon-γ autoantibodies or anti-granulocyte–macrophage colony-stimulating factor antibodies [14] , [15] .…”

“…Disseminated NTM infections are mainly found in patients with immunodeficiency, such as AIDS and leukemia/lymphoma, and in those with genetic defects or mutations (for examples, Mendelian susceptibility to mycobacterial disease, nuclear factor κB essential modulator mutation, signal transducer and activator of transcription 1 deficiency) or presence of anti-interferon-γ autoantibodies or anti-granulocyte–macrophage colony-stimulating factor antibodies [14] , [15] . In PLWHA, 70% to 94.6% of disseminated NTM infections were caused by MAIC [12] , [13] , [15] .…”

Management Challenges of Extrapulmonary Nontuberculous Mycobacterial Infection: A Single-Center Case Series and Literature Review

“…The emergence of late-onset NTM disease in patients typically indicates an acquired rather than a primary immunodeficiency. A striking example is the compromised CD4 T-cell-mediated immunity observed in HIV-infected patients, rendering them susceptible to disseminated NTM disease, particularly the M. avium complex [34].…”

Synthesis and Biological Characterization of Fluorescent Cyclipostins and Cyclophostin Analogues: New Insights for the Diagnosis of Mycobacterial-Related Diseases

“…They are associated with pulmonary diseases, accounting for >90% of all reported cases of NTM-pulmonary infection. , M. abscessus causes TB-like pulmonary diseases in immunocompromised and vulnerable individuals, including cystic fibrosis (CF) and bronchiectasis patients. − M. abscessus exists as two distinct colony morphotypes, smooth (S) and rough (R), which may evolve differently in response to host immunity, resulting in different fates for the mycobacteria in its host. − The R variant is often associated with severe pulmonary infections , and is likely to persist for years, especially in infected CF patients .…”