Detailed analysis of the radiographic presentation of Mycobacterium kansasii lung disease in patients with HIV infection.
BACKGROUND
Published criteria for the diagnosis of Mycobacterium kansasii lung disease require the presence of clinical symptoms, positive microbiologic results, and radiographic abnormalities. In patients with HIV infection, the radiographic findings of M kansasii lung disease are not well described.


METHODS
Medical records and chest radiographs of all patients with HIV infection and at least one respiratory specimen culture positive for M kansasii at San Francisco General Hospital between December 1989 and July 2002 were reviewed.


RESULTS
Chest radiographic results were abnormal in 75 of 83 patients (90%) included in the study. Radiographic abnormalities were diverse, with consolidation (66%) and nodules (42%) as the most frequent findings. The mid or lower lung zones were involved in 89% of patients. The pattern of radiographic abnormalities did not differ based on acid-fast bacilli smear status, the presence or absence of coexisting pulmonary infections, or CD4+ T-lymphocyte count. In multivariate Cox regression analysis, cavitation was the only radiographic abnormality independently associated with mortality (hazard ratio, 4.8; 95% confidence interval, 1.2 to 19.6).


CONCLUSIONS
Patients with HIV infection and M kansasii lung disease present with diverse radiographic patterns, most commonly consolidation and nodules predominantly located in the mid and lower lung zones. This finding is in contrast to the upper-lobe cavitary presentation described in patients without HIV infection. Although rare, the presence of cavitary disease in patients with HIV infection and M kansasii independently predicts worse outcome. The diversity in the radiographic presentation of M kansasii lung disease implies that clinicians should obtain sputum mycobacterial culture samples from any patient with HIV infection and an abnormal chest radiograph finding.
Cattamanchi
Adithya
A
University of California San Francisco, San Francisco General Hospital, San Francisco, CA 94110, USA. acattamanchi@medsfgh.ucsf.edu
Nahid
Payam
P
Marras
Theodore K
TK
Gotway
Michael B
MB
Lee
Theodore J
TJ
Gonzalez
Leah C
LC
Morris
Alison
A
Webb
W Richard
WR
Osmond
Dennis H
DH
Daley
Charles L
CL
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000382:microbiology*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000382:microbiology*; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000000981:diagnostic imaging*; D019909:Mycobacterium kansasii / Q000472:pathogenicity*; D011379:Prognosis; D011859:Radiography; D012044:Regression Analysis; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology