Chin D P, Hopewell P C, Yajko D M, Vittinghoff E, Horsburgh C R, Hadley W K, Stone E N, Nassos P S, Ostroff S M, Jacobson M A
San Francisco General Hospital Medical Center, CA 94110.
J Infect Dis. 1994 Feb;169(2):289-95. doi: 10.1093/infdis/169.2.289.
Mycobacterium avium complex (MAC) is frequently isolated from the respiratory or gastrointestinal tract of patients with advanced human immunodeficiency virus (HIV) infection. Whether they are at increased risk of MAC bacteremia and whether culture of respiratory tract or stool specimens is useful for predicting bacteremia are unclear. HIV-infected patients with < or = 50 CD4+ cells/microL were prospectively studied. The risk of MAC bacteremia was approximately 60% within 1 year for patients with MAC in either the respiratory or gastrointestinal tract and was greater than for those without MAC in these sites (relative hazards for respiratory and gastrointestinal tract, 2.3 and 6.0; 95% confidence intervals, 1.1-4.6 and 2.5-14.6, respectively). Both respiratory tract specimen and stool culture had poor sensitivities (22% and 20%, respectively) but good positive predictive values (approximately 60%) for bacteremia. Symptomatic HIV-infected patients with MAC in the respiratory or gastrointestinal tract are at a substantial risk for developing MAC bacteremia; culture of these sites has limited usefulness as a screening test.
鸟分枝杆菌复合群（MAC）常从晚期人类免疫缺陷病毒（HIV）感染患者的呼吸道或胃肠道中分离出来。目前尚不清楚这些患者发生MAC菌血症的风险是否增加，以及呼吸道或粪便标本培养对于预测菌血症是否有用。对CD4 +细胞/微升≤50的HIV感染患者进行了前瞻性研究。呼吸道或胃肠道存在MAC的患者在1年内发生MAC菌血症的风险约为60%，高于这些部位不存在MAC的患者（呼吸道和胃肠道的相对风险分别为2.3和6.0；95%置信区间分别为1.1 - 4.6和2.5 - 14.6）。呼吸道标本和粪便培养对菌血症的敏感性均较差（分别为22%和20%），但阳性预测值较好（约60%）。呼吸道或胃肠道存在MAC的有症状HIV感染患者发生MAC菌血症的风险很高；这些部位的培养作为筛查试验的作用有限。
