Mycobacterium kansasii and human immunodeficiency virus co-infection in London.
OBJECTIVE
although Mycobacterium kansasii infection has long been endemic in the U.K., the disease burden and characteristics of infection in the HIV-seropositive population has not been well documented. This study addresses these issues in an inner city population that comprises a quarter of all cases of acquired immunodeficiency syndrome (AIDS) reported in the U.K.


METHODS
retrospective review of case notes from two inner London specialist HIV Units.


RESULTS
twenty-nine cases of M. kansasii infection were identified, with case notes available for review in 26. Ten had pulmonary disease and nine had disseminated infection: a further seven patients appeared simply to be colonized (two respiratory and five gastrointestinal): M. kansasii was isolated from stool in over a third (nine of 26) of cases. Disseminated M. kansasii infection occurred in 0.44% of AIDS cases seen in our two units and all isolates were resistant to isoniazid ion vitro. A clinical response achieved in 11 of the 13 patients with M. kansasii-related disease who received anti-mycobacterial therapy. All four patients who relapsed following initial clinical response to therapy had received sub-optimal treatment.


CONCLUSIONS
the incidence of disseminated M. kansasii infection in HIV-infected individuals in the U.K. is similar to that seen in those from high prevalence regions of the U.S.A., and anti-mycobacterial therapy leads to a clinical response in the majority of patients with HIV and M. kansasii co-infection. The frequent isolation of M. kansasii from the stool suggests that the gastrointestinal tract may be a significant source of disseminated infection.
Klein
J L
JL
Department of Genitourinary Medicine, St. Mary's Hospital, London, UK.
Corbett
E L
EL
Slade
P M
PM
Miller
R F
RF
Coker
R J
RJ
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000382:microbiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D008171:Lung Diseases / Q000382:microbiology; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D019909:Mycobacterium kansasii / Q000187:drug effects / Q000302:isolation & purification*; D012189:Retrospective Studies
D000995:Antitubercular Agents