Patterns of mycobacterium avium culture and PCR positivity in immunodeficient HIV-infected patients: progression from localized to systematic disease, German Aids Study Group (GASG/IDKF).
Our aim was to establish the frequency and the longitudinal pattern of MAC culture positivity in late stage HIV-infected patients. Two other aims were to analyse risk factors for progression from localized to systemic disease and the value of PCR diagnosis using blood specimens. A total of 107 patients were recruited to be followed for 32 weeks. Prior MAC treatment and CD4 > 100/microliters were exclusion criteria. A total of 56 patients showed M. avium in at least 1 culture. 10/37 patients with MAC detected by culture first in 'non-sterile' specimens (stool, sputum) and urine progressed to systemic disease as determined by positive blood culture. Risk factors associated with this progression were a high symptom score at baseline, lymphadenopathy, anaemia, and low platelets. PCR was less sensitive than culture in detection of M. avium in blood specimens: Only 7/29 patients with positive blood cultures had a positive PCR at the same time. We conclude that symptomatic patients with advanced HIV-infection have a high frequency of MAC detection. Progression from localized to systemic culture positivity is associated with risk factors. Early 'pre-emptive' therapy is discussed.
Bogner
J R
JR
Medizinische Poliklinik, München, Germany.
Rüsch-Gerdes
S
S
Mertenskötter
T
T
Loch
O
O
Emminger
C
C
Baumgarten
R
R
Brockmeyer
N H
NH
Brockhaus
W
W
Jablonowski
H
H
Stoehr
A
A
Roth
A
A
Albrecht
H
H
Roth
K
K
Tschauder
S
S
Dietrich
M
M
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000382:microbiology; D000328:Adult; D004269:DNA, Bacterial / Q000302:isolation & purification; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000235:genetics / Q000302:isolation & purification; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications* / Q000382:microbiology; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies
D004269:DNA, Bacterial