Flepp M, Rhyner K, Lüthy R, Greminger P, Vurma-Rapp U, Wolfisberg C, Burnens A, Siegenthaler W
Departement für Innere Medizin, Universitätsspital, Zürich.
Dtsch Med Wochenschr. 1988 May 6;113(18):711-8. doi: 10.1055/s-2008-1067708.
Mycobacterial infections were confirmed in 629 HIV-infected persons (1.4%). Five patients had a generalized infection with Mycobacterium avium complex (MAC), four an extrapulmonary tuberculosis caused by Mycobacterium tuberculosis (M. tbc). In general, the tuberculosis was the first severe opportunistic infection, while infections with MAC were more frequent in patients with already manifest AIDS. Common to all patients were a septic temperature and definite shift to the left of neutrophil granulocytes. Four of five patients with MAC also had diarrhoea, and three of four with tuberculosis additionally had peripheral lymphomas. The chest x-ray films were normal in six of the nine patients. The diagnosis was made in six patients primarily by the microscopic demonstration of acid-fast bacteria in lymph node tissue or stool, in three patients by culture from blood or liver tissue. Microscopic stool examination was helpful: in three of five patients with MAC and one of two with M. tbc in the stool culture, acid-fast bacteria had already been demonstrated. In an individual case MAC infections could not be distinguished either clinically or morphologically from infections with M. tbc, but only by culture.
629名HIV感染者（1.4%）确诊患有分枝杆菌感染。5例患者发生播散性鸟分枝杆菌复合体（MAC）感染，4例患者发生由结核分枝杆菌（M. tbc）引起的肺外结核。总体而言，结核病是首例严重机会性感染，而MAC感染在已出现明显艾滋病症状的患者中更为常见。所有患者的共同症状是发热和中性粒细胞明显左移。5例MAC感染患者中有4例也有腹泻，4例结核病患者中有3例还患有外周淋巴瘤。9例患者中有6例胸部X光片正常。6例患者的诊断主要通过在淋巴结组织或粪便中显微镜下发现抗酸菌，3例患者通过血液或肝脏组织培养确诊。显微镜下粪便检查很有帮助：5例MAC感染患者中有3例以及2例粪便培养出M. tbc的患者中有1例，粪便中已发现抗酸菌。在个别病例中，MAC感染在临床或形态学上无法与M. tbc感染区分开来，只能通过培养鉴别。
