Diagnosis dan Tatalaksana Penyakit Paru Nontuberculous mycobacteria

Nontuberculous mycobacteria (NTM) juga dikenal dengan atypical mycobacteria atau mycobacteria other than tuberculosis merupakan organisme patogen oportunistik yang dapat menyebabkan penyakit paru progresif. Spesies yang paling banyak ditemukan adalah Mycobacteria avium complex (MAC), M. kansasii, M. malmose, dan M. xenopi. Diagnosis penyakit paru NTM berdasarkan manisfestasi klinis dan radiologis (fibrokavitas dan bronkiektasis nodular). Kultur merupakan standar emas untuk konfirmasi laboratorium dari NTM dan diperlukan untuk identifikasi genotipe dan drug suscebtibility test (DST). Antibiotik golongan makrolida seperti azitromisin dan klaritomisin merupakan terapi dasar untuk infeksi paru NTM. Rekomendasi menganjurkan terapi kombinasi makrolida (azitromisin atau klaritromisin), rifampin atau rifabutin, dan etambutol dengan atau tanpa aminoglikosida intravena. Terapi medikamentosa dilakukan secara kontiniu diberikan minimal selama 12 bulan setelah didapatkan biakan sputum negatif.

Prevalence of opportunistic infections in HIV-positive patients in Bahrain: a four-year review (2009-2013)

Introduction: This study aimed to examine the prevalence of opportunistic infections in HIV-infected patients in Bahrain and its relation to absolute CD4 count, CD4%, and CD4/CD8 ratio. Methodology: This retrospective cohort study used laboratory records (January 2009 - May 2013) from a major hospital in Bahrain. Opportunistic infections (OIs); absolute CD4 counts, CD4%, and CD4/CD8 ratio were recorded. Results: CD4% and absolute CD4 count in HIV patients with associated infections (157 ± 295) was significantly lower than in those without associated infections (471 ± 285) (p < 0.001). There was no significant difference in CD4/CD8 ratio between the two groups. Infection with Staphylococcus aureus was the commonest infection, present in 9.8% of total HIV-infected patients and 28.7% of members of the AIDS patient group with OIs, followed by yeast infections (9.2% and 27.2%, respectively). Mycobacterium tuberculosis was present in 3.6% of total HIV-infected patients and 10.6% of the group with OIs, while mycobacteria other than tuberculosis (MOTT) was present in 2.5% and 7.5%, respectively. Pneumocystis jirovecii pneumonia (PCP) was observed in 5.1% and 15.1%, respectively. Herpes simplex II (HSV-II) was observed in 3% and 9%, respectively, while Cytomegalovirus antigenemia was only present in 2% and 6%, respectively. Streptococcus pneumoniae, Streptococcus milleri, Stenotrophomonas maltophilia, and Citrobacter species were bacterial infections observed least frequently. Conclusions: Studying the pattern of OIs in HIV-infected patients in Bahrain is of paramount importance due to the scarcity of data in the Arab world. This will help to improve physicians’ awareness to improve care of HIV-infected patients.

Mycobacterium marinum infection complicated by anti-tumour necrosis factor therapy

Mycobacteria other than tuberculosis infections in patients taking various tumour necrosis factor (TNF)-α inhibitors have been reported in the literature. We describe sporotrichoid spread of Mycobacterium marinum in a man with Crohn's disease treated with infliximab. After starting ethambutol and rifampicin and discontinuing infliximab, a worsening appeared. M. marinum infection may have a potential local spread and systemic dissemination in patients treated with TNF-α inhibitors.