Al-Abdely H M, Revankar S G, Graybill J R
Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Centre at San Antonio, 7703 Floyd Curl, San Antonio, Texas 78284, USA.
J Infect. 2000 Sep;41(2):143-7. doi: 10.1053/jinf.2000.0700.
To report our experience with disseminated Mycobacterium simiae disease in patients with AIDS, and review other cases reported in the literature.
We retrospectively reviewed all cases of M. simiae that were isolated from sterile body sites over a 9-year period at the University Health System Hospital at San Antonio, Texas, U.S.A. Data included patient demographics, clinical features, other accompanying opportunistic infections, in vitro susceptibility, therapy and outcome.
Ten cases of M. simiae disseminated disease were identified. All of them were inpatients with AIDS. Another nine cases of disseminated infection in AIDS patients were reported in the literature. Advanced AIDS with absolute CD4 counts of less than 50 and an associated AIDS-defining illness characterized all cases. Persistent fever and debilitation without localizing signs were the most common clinical features. Our patients responded poorly to antimycobacterial drugs and died within 6 months of diagnosis. The only reported successful therapy was in patients who responded well to highly active antiretroviral therapy and antimycobacterial regimens containing clarithromycin, ethambutol and ciprofloxacin.
Clinical presentation of M. simiae infection mimics Mycobacterium avium complex, with fever and progressive debilitation, but is less responsive to therapy. Immuno-reconstitution with potent antiretroviral therapy may be the best therapy for such resistant disease.
报告我们对艾滋病患者播散性猿分枝杆菌病的治疗经验，并回顾文献中报道的其他病例。
我们回顾性分析了美国得克萨斯州圣安东尼奥市大学健康系统医院9年间从无菌身体部位分离出的所有猿分枝杆菌病例。数据包括患者人口统计学信息、临床特征、其他伴随的机会性感染、体外药敏试验、治疗方法及结果。
共鉴定出10例猿分枝杆菌播散性疾病病例。所有患者均为艾滋病住院患者。文献中还报道了另外9例艾滋病患者的播散性感染病例。所有病例均为晚期艾滋病患者，绝对CD4细胞计数低于50，且伴有艾滋病定义疾病。持续发热和虚弱但无定位体征是最常见的临床特征。我们的患者对抗分枝杆菌药物反应不佳，在诊断后6个月内死亡。唯一报道的成功治疗案例是对高效抗逆转录病毒治疗以及包含克拉霉素、乙胺丁醇和环丙沙星的抗分枝杆菌治疗方案反应良好的患者。
猿分枝杆菌感染的临床表现与鸟分枝杆菌复合体相似，表现为发热和进行性虚弱，但对治疗反应较差。强效抗逆转录病毒治疗实现免疫重建可能是此类耐药疾病的最佳治疗方法。
