scholarly journals 830. Central Nervous System Involvement in Disseminated Mycobacterium avium Complex Infection in Patients with Newly Diagnosed HIV

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S507-S507
Author(s):  
Antonio Camiro ◽  
Andrea Llamas-López ◽  
Mercedes Aranda-Audelo ◽  
David H Martínez-Oliva ◽  
Estefania Sienra-Iracheta ◽  
...  
Keyword(s):  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Opportunistic Infections ◽  
Central Nervous System Involvement ◽  
Case Series ◽  
Hiv Diagnosis ◽  
Retrospective Case ◽  
Disseminated Infection ◽  
Csf Analysis ◽  
Important Note

Abstract Background Disseminated Mycobacterium avium complex (MAC) infection occurs in 20-40% of patients with < 50 CD4/mm3. Data describing central nervous MAC involvement (CNS-MAC) in disseminated infection is scarce. Methods We conducted a retrospective case series in the outpatient infectious diseases clinic in the hospital “Dr. Manuel Gea Gonzales” in Mexico City. We reviewed all records from October 2020 to May 2021 and identified all culture proven MAC infections. Results We found 7 cases of MAC, with disseminated infection (positive bone marrow cultures) with 3 out of those 7 meeting our definition for CNS-MAC (positive cerebrospinal fluid culture). All cases of CNS-MAC infection occurred in patients with < 50 CD4/mm3 and recent HIV diagnosis (1-4 months) that were referred to our institution with consumptive syndrome and fevers. All patients were receiving antiretroviral treatment (ART) with BIC/FTC/TAF and initiated ART in less than 1 month since HIV diagnosis. Opportunistic infections were ruled-out at the moment of CNS-MAC diagnosis (criptococcal meningitis, cytomegalovirus retinitis, tuberculosis and histoplasmosis). All patients exhibited non-specific neurologic symptoms at arrival (headache and bradipsiquia) mixed with more severe symptoms (one case of ataxia, one case of vertigo, one case of III nerve palsy). All patients were treated with Clarithromycin/Levofloxacin/Ethambutol. Two patients achieved symptom remission and 1 patient was lost to follow-up. Of important note, all CSF analysis and CNS imaging studies carried-out were normal. No MAC bacilli were identified with direct Ziel-Neelsen staining of CSF. Conclusion We found a high proportion of CNS-MAC in patients with disseminated MAC infection (42.8%) during the study period. All patients presented CNS symptoms and normal CSF characteristics. In our setting, patients with suspected disseminated MAC infection CD4 counts < 50 cells/mm3 might represent a specific population that could benefit from routine targeted diagnostic test at presentation in order to establish CNS involvement. Disclosures All Authors: No reported disclosures

scholarly journals Treatment of Complicated Henoch-Schönlein Purpura with Mycophenolate Mofetil: A Retrospective Case Series Report

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
A. A. Nikibakhsh ◽  
H. Mahmoodzadeh ◽  
M. Karamyyar ◽  
S. Hejazi ◽  
M. Noroozi ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Steroid Therapy ◽  
Central Nervous System Involvement ◽  
Case Series ◽  
Systemic Steroid ◽  
Henoch Schonlein Purpura ◽  
Retrospective Case ◽  
Frequent Relapses ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

Background. Henoch-Schönlein purpura (HSP) is the most common childhood vasculitis with an incidence of approximately 10 per 100 000 children. There is some evidence to support steroid therapy in the treatment of severe abdominal pain, severe nephritis, and central nervous system involvement. However, the routine use of corticosteroids is controversial. Frequent relapses, lack of response to steroid, steroid dependency, and steroid side effects may occur in some patients. Mycophenolate mofetil (MMF) gains increasing popularity in the treatment of autoimmune disorders, but hitherto, the available evidence to support the use of MMF in HSP is limited to some case study reports.Case Presentation. We report six children with HSP who failed to respond to systemic steroid therapy, whereas MMF successfully treated the manifestations of the disease.Conclusion. The manifestations of HSP disappeared mainly during the first week of treatment with MMF and all the patients were in a complete remission at the end and after discontinuation of the therapy. In our experience, MMF appeared to be safe and effective for the maintenance of remission in the HSP patients.

Late cerebral relapse of a Mycobacterium avium complex disseminated infection in an HIV-infected patient after cessation of antiretroviral therapy

AIDS ◽  
2003 ◽  
Vol 17 (9) ◽  
pp. 1410-1411 ◽  
Author(s):  
Anne-Sophie Lascaux ◽  
Philippe Lesprit ◽  
Lionel Deforges ◽  
Cristina Gutierrez ◽  
Yves Lévy
Keyword(s):  
Antiretroviral Therapy ◽  
Mycobacterium Avium ◽  
Infected Patient ◽  
Mycobacterium Avium Complex ◽  
Disseminated Infection

A 71-year-old man with recurrent pulmonary mycobacterial avium complex infections and lymphopenia

2020 ◽  
Vol 41 (1) ◽  
pp. 66-69 ◽  
Author(s):  
Taha Al-Shaikhly ◽  
Frederick S. Buckner ◽  
Matthew C. Altman ◽  
Hans D. Ochs ◽  
Andrew G. Ayars
Keyword(s):  
Human Immunodeficiency Virus ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Opportunistic Infections ◽  
Clinical Course ◽  
Critical Role ◽  
T Cell Immunity ◽  
Cell Immunity ◽  
Immunodeficiency Disorder ◽  
Immunodeficiency Virus

Mycobacterium avium complex (MAC) infections, generally viewed as opportunistic infections, often trigger an evaluation for an underlying immunodeficiency disorder. However, MAC infections can occur in patients who presumably are immunocompetent, particularly in those with an underlying structural lung disease. T-cell immunity plays a critical role in controlling MAC infection. We presented a case of lymphopenia, which complicated the clinical course of a pulmonary MAC infection in a patient who was negative for human immunodeficiency virus.

scholarly journals Lymph node co-infection of Mycobacterium avium complex and cytomegalovirus in an acquired immunodeficiency syndrome patient

2013 ◽  
Vol 5 (1) ◽  
pp. 2 ◽  
Author(s):  
Arya Hedjazi ◽  
Marzieh Hosseini ◽  
Amin Hoseinzadeh
Keyword(s):  
Human Immunodeficiency Virus ◽  
Lymph Node ◽  
Mycobacterium Avium ◽  
Acquired Immunodeficiency Syndrome ◽  
Mycobacterium Avium Complex ◽  
Opportunistic Infections ◽  
Lymph Node Involvement ◽  
Immunodeficiency Virus ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

Acquired immunodeficiency syndrome patients are known to have an increased tendency for developing opportunistic infections. However, there are no reports of simultaneous lymph node involvement of <em>cytomegalovirus</em> and <em>Mycobacterium avium complex</em> in a human immunodeficiency virus-positive patient. We report a 31-year-old man who presented with acute abdominal pain and tenderness and weight loss. He died a few hours after admission. Autopsy studies showed coinfection of <em>cytomegalovirus</em>, <em>Mycobacterium avium complex</em> and <em>human immunodeficiency virus</em>. Our case emphasizes the need to be careful in evaluating opportunistic infections in severely immunodepressed acquired immunodeficiency syndrome patients. This case report is the first manifestation of acquired immunodeficiency syndrome in this patient.

scholarly journals Recurrent Disseminated Infection with Mycobacterium avium Complex Identified in Tissues by Molecular Analysis

1996 ◽  
Vol 22 (4) ◽  
pp. 714-715 ◽  
Author(s):  
R. O. Darouiche ◽  
A. Koff ◽  
T. Rosen ◽  
T. V. Darnule ◽  
M. D. Lidsky ◽  
...  
Keyword(s):  
Molecular Analysis ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Disseminated Infection

scholarly journals Genotyping of Mycobacterium avium complex organisms using multispacer sequence typing

Microbiology ◽  
2010 ◽  
Vol 156 (3) ◽  
pp. 687-694 ◽  
Author(s):  
Caroline Cayrou ◽  
Christine Turenne ◽  
Marcel A. Behr ◽  
Michel Drancourt
Keyword(s):  
Genome Sequence ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Opportunistic Infections ◽  
New Method ◽  
Mycobacterium Intracellulare ◽  
Intergenic Spacers ◽  
Genotyping Method ◽  
Multispacer Sequence Typing ◽  
Reference Strains

Mycobacterium avium complex (MAC) currently comprises eight species of environmental and animal-associated, slowly-growing mycobacteria: Mycobacterium avium, Mycobacterium intracellulare, Mycobacterium chimaera, Mycobacterium colombiense, Mycobacterium arosiense, Mycobacterium bouchedurhonense, Mycobacterium marseillense and Mycobacterium timonense. In humans, MAC organisms are responsible for opportunistic infections whose unique epidemiology remains poorly understood, in part due to the lack of a genotyping method applicable to all eight MAC species. In this study we developed multispacer sequence typing (MST), a sequencing-based method, for the genotyping of MAC organisms. An alignment of the genome sequence of M. avium subsp. hominissuis strain104 and M. avium subsp. paratuberculosis strain K-10 revealed621 intergenic spacers <1000 bp. From these, 16 spacers were selected that ranged from 300 to 800 bp and contained a number of variable bases, <50 within each of the 16 spacers. Four spacers were successfully PCR-amplified and sequenced in 11 reference strains. Combining the sequence of these four spacers in 106 MAC organisms, including 83 M. avium, 11 M. intracellulare, six M. chimaera, two M. colombiense and one each of M. arosiense, M. bouchedurhonense, M. marseillense and M. timonense, yielded a total of 45 spacer types, with an index of discrimination of 0.94. Each spacer type was specific for a species and certain spacer types were specific for subspecies of M. avium. MST is a new method for genotyping of organisms belonging to any one of the eight MAC species tested in this study.

scholarly journals The Mycobacterium avium complex.

1993 ◽  
Vol 6 (3) ◽  
pp. 266-310 ◽  
Author(s):  
C B Inderlied ◽  
C A Kemper ◽  
L E Bermudez
Keyword(s):  
Antimicrobial Resistance ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Antimicrobial Agents ◽  
Opportunistic Infections ◽  
Laboratory Diagnosis ◽  
Molecular Techniques ◽  
Critical Threshold ◽  
Therapeutic Modalities ◽  
The Past

Mycobacterium avium complex (MAC) disease emerged early in the epidemic of AIDS as one of the common opportunistic infections afflicting human immunodeficiency virus-infected patients. However, only over the past few years has a consensus developed about its significance to the morbidity and mortality of AIDS. M. avium was well known to mycobacteriologists decades before AIDS, and the MAC was known to cause disease, albeit uncommon, in humans and animals. The early interest in the MAC provided a basis for an explosion of studies over the past 10 years largely in response to the role of the MAC in AIDS opportunistic infection. Molecular techniques have been applied to the epidemiology of MAC disease as well as to a better understanding of the genetics of antimicrobial resistance. The interaction of the MAC with the immune system is complex, and putative MAC virulence factors appear to have a direct effect on the components of cellular immunity, including the regulation of cytokine expression and function. There now is compelling evidence that disseminated MAC disease in humans contributes to both a decrease in the quality of life and survival. Disseminated disease most commonly develops late in the course of AIDS as the CD4 cells are depleted below a critical threshold, but new therapies for prophylaxis and treatment offer considerable promise. These new therapeutic modalities are likely to be useful in the treatment of other forms of MAC disease in patients without AIDS. The laboratory diagnosis of MAC disease has focused on the detection of mycobacteria in the blood and tissues, and although the existing methods are largely adequate, there is need for improvement. Indeed, the successful treatment of MAC disease clearly will require an early and rapid detection of the MAC in clinical specimens long before the establishment of the characteristic overwhelming infection of bone marrow, liver, spleen, and other tissue. Also, a standard method of susceptibility testing is of increasing interest and importance as new effective antimicrobial agents are identified and evaluated. Antimicrobial resistance has already emerged as an important problem, and methods for circumventing resistance that use combination therapies are now being studied.

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