Non-Tuberculous Mycobacterial Infection in AIDS Patients: A Detailed Description of 4 Cases, Including Histopathological Finding

Abstract

Non tuberculous mycobacteria (NTM) are important opportunistic infection in patients with AIDS.

Aim: To present 4 cases of disseminated infections by NTM in patients with AIDS.

Results: These cases were associated with prolonged symptoms of fever, weight loss, diarrhea or cough, with hepatosplenomegaly, anemia and thrombocytopenia. None were receiving prophylaxis, had a low CD4 lymphocyte count (median 20/mm3), and three had discontinued their antiretroviral therapy (ART). The diagnosis was established by culture in bone marrow, sputum or bronchioalveolar lavage samples and in two cases also by PCR. Histological features included foamy histiocytes and positive acid fast bacilli in tissues. The species identified were Mycobacterium avium in 3 cases and M. genavense in the remaining case. Patients were treated with combinations of ethambutol, macrolides, quinolones, amikacin or rifampicin on a long-term basis (median 19 months) and even parenterally for severe diarrhea. Three patients survived and one died from disseminated Kaposi's sarcoma. Multiple complications were observed including severe malnutrition, renal failure, calcium and phosphorus metabolism disorders, healthcare-associated infections, co-infections, and neoplasms. All required readmissions and ART adjustments to compensate for interactions with rifampicin.

Conclusions: NTM infections in patients with AIDS generate a prolonged morbidity, frequent readmissions, require an extended combination treatment that may present interactions with ART, and are associated with different complications, including calcium and phosphorus disorders. Its diagnosis is complex in the absence of special blood cultures, requiring a microbiological study in multiple samples and with different techniques, including the support of histopathology.