[Infections with Mycobacterium kansasii in the Academic Medical Center in Amsterdam: the changing clinical spectrum since the start of the HIV epidemic].
OBJECTIVE
Inventory of patients with a Mycobacterium kansasii infection.


METHODS
Descriptive, retrospective.


METHODS
Academic Medical Centre, Amsterdam, the Netherlands.


METHODS
Review of the medical records of all patients with a bacteriologically confirmed infection with M. kansasii from January 1987 until the end of December 1996.


RESULTS
M. kansasii was isolated from 17 patients. Of 15 HIV-tested patients 13 were seropositive. Their median CD4 count was 10 x 10(6)/l. Ten HIV-positive individuals used trimethoprim-sulfamethoxazole prophylaxis. In 1 HIV-seropositive and in 1 HIV-seronegative patient no chest X-rays were made. Caverns were present in none of 12 HIV-positive patients and in 1 of 3 HIV-negative patients. Of the HIV-positive patients 1 fulfilled the criteria for pulmonary infection of the American Thoracic Society (ATS). According to these criteria 9 of the HIV-positive patients were colonized with M. kansasii. In 6 of these patients there were indications of infection: regression of pulmonary infiltrates with therapy (n = 3), positive histology and culture of lung tissue at autopsy (n = 1), and dissemination (n = 2). Disseminated infection occurred in a total of 4 HIV-infected patients.


CONCLUSIONS
HIV-infected patients are at an increased risk for M. kansasii infection. Trimethoprim-sulfamethoxazole does not offer protection against this infection. The diagnostic criteria of the ATS are not applicable to these patients. M. kansasii infection confirmed by isolation in an HIV-positive individual should always be treated.
van der Meer
J T
JT
Academisch Medisch Centrum, Amsterdam.
Kerssemakers
S P
SP
van Steenwijk
R P
RP
Kuijper
E J
EJ
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis; D006801:Humans; D017053:Infection Control / Q000592:standards; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D019909:Mycobacterium kansasii / Q000302:isolation & purification* / Q000472:pathogenicity; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D014296:Trimethoprim Resistance; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D015662:Trimethoprim, Sulfamethoxazole Drug Combination
Infecties met mycobacterium kansasii in het Academisch Medisch Centrum in Amsterdam: het klinisch beeld sinds het begin van de HIV-epidemie.