title: 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).
abstract: 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.
authors.affiliation: Medizinische Poliklinik, München, Germany.
authors.forename: J R
authors.initials: JR
authors.lastname: Bogner
authors.forename: S
authors.initials: S
authors.lastname: Rüsch-Gerdes
authors.forename: T
authors.initials: T
authors.lastname: Mertenskötter
authors.forename: O
authors.initials: O
authors.lastname: Loch
authors.forename: C
authors.initials: C
authors.lastname: Emminger
authors.forename: R
authors.initials: R
authors.lastname: Baumgarten
authors.forename: N H
authors.initials: NH
authors.lastname: Brockmeyer
authors.forename: W
authors.initials: W
authors.lastname: Brockhaus
authors.forename: H
authors.initials: H
authors.lastname: Jablonowski
authors.forename: A
authors.initials: A
authors.lastname: Stoehr
authors.forename: A
authors.initials: A
authors.lastname: Roth
authors.forename: H
authors.initials: H
authors.lastname: Albrecht
authors.forename: K
authors.initials: K
authors.lastname: Roth
authors.forename: S
authors.initials: S
authors.lastname: Tschauder
authors.forename: M
authors.initials: M
authors.lastname: Dietrich
mesh_terms: 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
chemical_list: D004269:DNA, Bacterial