Blázquez R, Ruiz-Serrano M J, Muñoz P, Miralles P, Pérez-Tascón M, Bouza E
Servicio de Microbiología Clínica y Enfermedades Infecciosas-VIH, Hospital General Universitario Gregorio Marañón, Madrid.
Rev Clin Esp. 1997 Mar;197(3):158-62.
Since the emergence of AIDS, disseminated Mycobacterium avium complex (MAC) infection has become a growing cause of morbidity and mortality in this group of patients. Our objective was to study the incidence and the clinical and microbiological features of MAC infection in HIV-positive patients as well as the response to a therapy regimen combining clarithromycin and ethambutol. At our hospital, the first patient with disseminated MAC infection was diagnosed in 1988. Since then, 54 HIV-positive patients with MAC infection have been diagnosed (30/1,000 HIV-positive patients). MAC represented 12% of recovered mycobacteria in HIV-positive patients and this percentage has increased from 3.9% in 1988 to 16.4% in 1994. All episodes of MAC infection occurred in patients with advanced HIV diseases (mean CD4: 73/microliter). MAC infection was the disease diagnosing AIDS in 23.4% of cases. The most common clinical manifestations included fever (85.7%), weight loss (55%), and pulmonary involvement (50%). A total of 55 specimens were processed for mycobacterial culture from 54 patients (mean of 10.2 specimens per patient). A total of 122 were positive (21.9%: 2.25 positive specimens per patient). The specimens with the greater percentage of positive results were bone marrow aspirates (65.3%) and blood cultures (47.7%), followed by respiratory (16.5%) and urine specimens (5.3%). Regarding therapy, sixteen of the 54 investigated patients did not receive specific drugs for MAC infection, 7 were treated with different combinations of active drugs against MAC (rifampin, clofazimine, amikacin, ethambutol, and isoniazid) and 31 received a combination of clarythromicin (1 g/12 hourly) and ethambutol (400 mg/12 hourly). Seventy-four percent of patients treated with clarythromicin and ethambutol improved clinically, and the mean survival time in these patients (253 days) was significantly longer than that in not treated patients (p < 0.05). No significant differences were noted in survival time between the group of patients treated with clarythromicin and ethambutol and that with other drug combinations. The incidence of disseminated MAC infection in our environment is increasing in patients with advanced HIV disease. The combination of clarythromicin plus ethambutol was well tolerated and efficient for the treatment of disseminated MAC infection.
自艾滋病出现以来，播散性鸟分枝杆菌复合体（MAC）感染已成为这类患者发病和死亡的一个日益常见的原因。我们的目的是研究HIV阳性患者中MAC感染的发病率、临床和微生物学特征以及对克拉霉素和乙胺丁醇联合治疗方案的反应。在我们医院，1988年诊断出首例播散性MAC感染患者。从那时起，已诊断出54例HIV阳性的MAC感染患者（每1000例HIV阳性患者中有30例）。MAC在HIV阳性患者分离出的分枝杆菌中占12%，这一比例已从1988年的3.9%增至1994年的16.4%。所有MAC感染病例均发生在HIV疾病晚期患者中（平均CD4：73/微升）。在23.4%的病例中，MAC感染是诊断艾滋病的疾病。最常见的临床表现包括发热（85.7%）、体重减轻（55%）和肺部受累（50%）。对54例患者共55份标本进行了分枝杆菌培养（平均每位患者10.2份标本）。共有122份标本呈阳性（21.9%：每位患者平均2.25份阳性标本）。阳性率较高的标本是骨髓抽吸物（65.3%）和血培养（47.7%），其次是呼吸道标本（16.5%）和尿液标本（5.3%）。关于治疗，54例接受调查的患者中有16例未接受针对MAC感染的特定药物治疗，7例接受了针对MAC的不同活性药物组合治疗（利福平、氯法齐明、阿米卡星、乙胺丁醇和异烟肼），31例接受了克拉霉素（1克/12小时）和乙胺丁醇（400毫克/12小时）的联合治疗。接受克拉霉素和乙胺丁醇治疗的患者中有74%临床症状改善，这些患者的平均生存时间（253天）显著长于未治疗患者（p<0.05）。接受克拉霉素和乙胺丁醇治疗的患者组与接受其他药物组合治疗的患者组在生存时间上无显著差异。在我们所处环境中，晚期HIV疾病患者播散性MAC感染的发病率正在上升。克拉霉素加乙胺丁醇联合用药耐受性良好，对播散性MAC感染治疗有效。
