Dhungana G P, Ghimire P, Sharma S, Rijal B P
Department of Microbiology, Siddhanath Science Campus, Mahendranagar, Kanchanpur, Nepal.
JNMA J Nepal Med Assoc. 2008 Jan-Mar;47(169):18-23.
Besides Mycobacterium tuberculosis, a number of other Mycobacterium species are also occasional human pathogens. Tuberculosis due to Mycobacterium avium complex (MAC) and Mycobacterium kansasii is particularly prevalent in AIDS patients as compared to the normal population. A cross-sectional study was carried out during January 2004 to August 2005 in 100 HIV-infected persons visiting Tribhuvan University, Teaching Hospital, and about a dozen of HIV/AIDS care centers of Kathmandu with the objectives to characterize the different mycobacterial species in HIV/AIDS patients. Three sputum specimens from each person were used to investigate tuberculosis by Ziehl-Neelsen staining, culture and identification tests. Among the 100 HIV-infected cases, 66 (66%) were males and 34 (34%) were females. Sixty percent of the cases were in the age group of 21-30 years. Mycobacteria were detected in 23 (23%) HIV cases of which 15 (65.2%) were in the age group of 21-30 years ; 17(74%) were males and 6 (26 %) were females. Among 23 co-infected cases, 22 were culture positive for mycobacteria. Among these, the predominant one was Mycobacterium avium complex (MAC), 9 (41%), followed by M. tuberculosis, 6 (27%), M .kansasii, 4 (18%), M. fortuitum, 2 (10%) and M. chelonae 1 (4%). Significant relationship was established between smoking/alcoholism and the subsequent development of tuberculosis (chi(2)=7.24, p<0.05 for smoking habit and chi(2)=4.39, p<0.05 for alcoholism). Fourteen (61%) co-infected cases presented with weight loss and cough whereas diarrhea was presented only by those patients with atypical mycobacterial co-infection, which was as high as 5 (56%) in patients with MAC co-infection. This study demonstrated the predominance of atypical mycobacteria, mainly MAC, in HIV/AIDS cases and most of them were from sputum smear-negative cases.
除结核分枝杆菌外，其他一些分枝杆菌种类偶尔也会成为人类病原体。与正常人群相比，鸟分枝杆菌复合群（MAC）和堪萨斯分枝杆菌所致的结核病在艾滋病患者中尤为普遍。2004年1月至2005年8月期间，对前往特里布万大学教学医院就诊的100名艾滋病毒感染者以及加德满都约12家艾滋病毒/艾滋病护理中心的患者进行了一项横断面研究，目的是对艾滋病毒/艾滋病患者中的不同分枝杆菌种类进行特征描述。每人采集三份痰标本，通过萋尼氏染色、培养和鉴定试验来调查结核病情况。在100例艾滋病毒感染病例中，男性66例（66%），女性34例（34%）。60%的病例年龄在21至30岁之间。在23例（23%）艾滋病毒病例中检测到分枝杆菌，其中15例（65.2%）年龄在21至30岁之间；17例（74%）为男性，6例（26%）为女性。在23例合并感染病例中，22例分枝杆菌培养呈阳性。其中，主要的是鸟分枝杆菌复合群（MAC），9例（41%），其次是结核分枝杆菌，6例（27%），堪萨斯分枝杆菌，4例（18%），偶然分枝杆菌，2例（10%），龟分枝杆菌1例（4%）。吸烟/酗酒与随后发生结核病之间建立了显著关联（吸烟习惯：卡方值=7.24，p<0.05；酗酒：卡方值=4.39，p<0.05）。14例（61%）合并感染病例出现体重减轻和咳嗽，而腹泻仅出现在非典型分枝杆菌合并感染的患者中，在MAC合并感染的患者中高达5例（56%）。本研究表明，在艾滋病毒/艾滋病病例中，非典型分枝杆菌占主导地位，主要是MAC，且大多数来自痰涂片阴性病例。
