Levine B, Chaisson R E
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Intern Med. 1991 May 15;114(10):861-8. doi: 10.7326/0003-4819-114-10-861.
To assess the clinical features and response to therapy of Mycobacterium kansasii infection in patients with human immunodeficiency virus (HIV) infection.
We reviewed the records of all patients with M. kansasii and HIV infection treated between January 1985 and June 1990.
The Johns Hopkins Hospital, Baltimore, Maryland.
Nineteen patients with M. kansasii and HIV infection were identified; 14 patients had exclusive pulmonary infection, 3 patients had pulmonary and extrapulmonary infection, and 2 patients had exclusive extrapulmonary infection. At the time of diagnosis of M. kansasii infection, the median CD4+ lymphocyte count was 49 cells/microL (range, 0 to 198 cells/microL), and 16 of 19 patients had a previous diagnosis of the acquired immunodeficiency syndrome (AIDS). All 17 patients with pulmonary infection presented with fever and cough of at least 2 weeks duration. Chest radiographs showed either focal upper lobe infiltrates (n = 8) or diffuse interstitial infiltrates (n = 9); 9 patients also had thin-walled cavitary lesions. Nine patients with pulmonary M. kansasii infection were treated with antituberculosis chemotherapy, with resolution of fever and respiratory symptoms, improvement of radiographic infiltrates, and sputum conversion; 1 patient with M. kansasii osteomyelitis also responded to antituberculosis therapy. Autopsies done on 3 treated patients did not reveal any evidence of M. kansasii infection. Nine patients did not receive any antituberculosis chemotherapy; 2 untreated patients developed progressive cavitary pulmonary disease and died from M. kansasii pneumonia.
Mycobacterium kansasii causes serious and potentially life-threatening pulmonary disease in patients with advanced HIV-related immunosuppression. In contrast to previous reports, our findings indicate that disease produced by M. kansasii in patients with HIV infection is responsive to antituberculosis chemotherapy.
评估人类免疫缺陷病毒（HIV）感染患者堪萨斯分枝杆菌感染的临床特征及对治疗的反应。
我们回顾了1985年1月至1990年6月期间所有接受治疗的堪萨斯分枝杆菌和HIV感染患者的记录。
马里兰州巴尔的摩市约翰霍普金斯医院。
确定了19例堪萨斯分枝杆菌和HIV感染患者；14例患者为单纯肺部感染，3例患者为肺部和肺外感染，2例患者为单纯肺外感染。在诊断堪萨斯分枝杆菌感染时，CD4 +淋巴细胞计数中位数为49个细胞/微升（范围为0至198个细胞/微升），19例患者中有16例先前被诊断为获得性免疫缺陷综合征（AIDS）。所有17例肺部感染患者均出现持续至少2周的发热和咳嗽。胸部X线片显示局灶性上叶浸润（n = 8）或弥漫性间质浸润（n = 9）；9例患者还伴有薄壁空洞性病变。9例肺部堪萨斯分枝杆菌感染患者接受了抗结核化疗，发热和呼吸道症状消退，影像学浸润改善，痰菌转阴；1例堪萨斯分枝杆菌骨髓炎患者对抗结核治疗也有反应。对3例接受治疗的患者进行尸检未发现堪萨斯分枝杆菌感染的任何证据。9例患者未接受任何抗结核化疗；2例未治疗患者发生进行性空洞性肺病，死于堪萨斯分枝杆菌肺炎。
堪萨斯分枝杆菌在晚期HIV相关免疫抑制患者中可引起严重且可能危及生命的肺部疾病。与先前的报告相反，我们的研究结果表明，HIV感染患者中由堪萨斯分枝杆菌引起的疾病对抗结核化疗有反应。
