Kemper C A, Havlir D, Bartok A E, Kane C, Camp B, Lane N, Deresinski S C
Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128.
J Infect Dis. 1994 Aug;170(2):488-93. doi: 10.1093/infdis/170.2.488.
It is generally assumed that Mycobacterium avium complex (MAC) bacteremia, once it develops, is unremitting. On the basis of this presumption, changes in the level of mycobacteremia are used to gauge therapeutic response. In 7 (12%) of 60 patients enrolled in a prospective trial of MAC bacteremia and AIDS, bacteremia became undetectable before the initiation of antimycobacterial therapy. Patients with transient bacteremia reported fewer and shorter symptoms and survived longer than those with sustained bacteremia (59 vs. 31 weeks; P = .022). There was no difference in the duration of AIDS, CD4+ cell count, hematocrit, or body weight between groups. Two additional patients with transient bacteremia were identified outside this study setting. Despite disappearance of detectable mycobacteremia and subsequent administration of antimycobacterial agent(s), bacteremia once again became detectable in 6 patients 4-45 weeks after their negative pretreatment cultures. Patients with disseminated MAC may have fluctuating levels of mycobacteremia that become undetectable in the absence of antimycobacterial therapy.
一般认为，鸟分枝杆菌复合群（MAC）菌血症一旦发生，便会持续存在。基于这一假设，分枝杆菌血症水平的变化被用于评估治疗反应。在一项针对MAC菌血症与艾滋病的前瞻性试验中，60名患者中有7名（12%）在开始抗分枝杆菌治疗前，其菌血症已无法检测到。与持续性菌血症患者相比，短暂性菌血症患者报告的症状更少、持续时间更短，且存活时间更长（59周对31周；P = 0.022）。两组之间在艾滋病病程、CD4 +细胞计数、血细胞比容或体重方面没有差异。在本研究范围之外又发现了另外两名短暂性菌血症患者。尽管可检测到的菌血症消失，随后也给予了抗分枝杆菌药物治疗，但仍有6名患者在预处理培养结果呈阴性后的4 - 45周，菌血症再次变得可检测到。播散性MAC患者的分枝杆菌血症水平可能会波动，在未进行抗分枝杆菌治疗的情况下会变得无法检测到。
