Endobronchial Mycobacterium avium-intracellulare infection in a patient with AIDS

Endobronchial Mycobacterium Avium-Intracellulare Infection in Lung Transplant Recipients

Endobronchial Mycobacterium avium-intracellulare (MAI) infection has been described in immunocompromised patients but is rare among transplant recipients. We present a case of a 48-year-old male with a history of coal miners' pneumoconiosis who underwent bilateral lung transplantation. Ten months post-transplant, despite normal spirometry and absence of respiratory symptoms, routine surveillance bronchoscopy revealed multiple endobronchial polypoid lesions. Biopsy demonstrated non-necrotizing granulomatous inflammation, with cultures confirming MAI infection. This case underscores the importance of maintaining a high index of suspicion for atypical infections like MAI in lung transplant recipients, even in the absence of overt clinical symptoms. This case's unique presentation adds to our understanding of potential post-transplant complications and may help clinicians recognize similar presentations in the future.

The diagnosis of multiple opportunistic infections in advanced stage AIDS: when Ockham's Razor doesn't cut it

In the advanced stage of AIDS, the diagnosis of the opportunistic infections may be challenging due to the high risk of performing invasive diagnostic methods in a patient with a critical clinical condition, as well as the correct interpretation of the results of microbiological exams. One of the challenges for the diagnosis and treatment of the opportunistic infections is that they may occur concomitantly in the same patient and they may mimic each other, leading to a high discrepancy between clinical and autopsy diagnoses. We describe the case of a 52-year-old man who was hospitalized because of weight loss, anemia, cough, and hepatosplenomegaly. During the investigation, the diagnosis of AIDS was made, and the patient developed respiratory failure and died on the fourth day of hospitalization. At autopsy, disseminated non-tuberculosis mycobacteriosis was found, affecting mainly the organs of the reticuloendothelial system. Also, severe and diffuse pneumonia caused by multiple agents (Pneumocystis jirovecii , Histoplasma capsulatum, suppurative bacterial infection, non-tuberculosis mycobacteria, and cytomegalovirus) was seen in a morphological pattern that could be called "collision pneumonia." The lesson from this case, revealed by the autopsy, is that in advanced AIDS, patients often have multiple opportunistic infections, so the principle of Ockham's razor-that a single diagnosis is most likely the best diagnosis-fails in this clinical context.

Isolated Endobronchial Mycobacterium avium Disease Associated with Lobar Atelectasis in an Immunocompetent Young Adult: A Case Report and Literature Review

The prevalence of lung diseases caused by nontuberculous mycobacteria (NTM) is increasing worldwide. Unlike pulmonary tuberculosis, endobronchial NTM diseases are very rare with the majority of cases reported in patients with human immunodeficiency virus infection and acquired immune deficiency syndrome. We reported a rare case of endobronchial Mycobacterium avium disease associated with lobar atelectasis in a young immunocompetent patient and reviewed the relevant iterature.

Mycobacterium intracellulare Pulmonary Disease with Endobronchial Caseation in a Patient Treated with Methotrexate

Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.

Mycobacterium avium-intracellulare presenting as an endobronchial tumour due to immune reconstitution inflammatory syndrome

Mycobacterium avium-intracellulare (MAI) infection in an HIV-positive patient can present shortly after starting antiretroviral therapy, as a result of immune reconstitution inflammatory syndrome (IRIS). We report a case of a 33-year-old woman where MAI presented as an endobronchial tumour due to IRIS. She responded well to standard anti-MAI treatment (rifamycins, macrolide and ethambutol).

Mycobacterium avium complex infection presenting as an endobronchial mass in a patient with acquired immune deficiency syndrome

Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with AIDS (acquired immune deficiency syndrome). Pulmonary involvement of MAC may range from asymptomatic colonization of the respiratory tract to invasive parenchymal or cavitary disease. However, endobronchial lesions with MAC infection are rare in immunocompetent and immunosuppressed hosts. Here, we report MAC infection presenting as an endobronchial mass in a patient with AIDS.

Mycobacterium kansasii endobronchial ulcer in a nonimmunocompromised patient

In this report we describe the case of an immunocompetent patient found to have an endobronchial, ulcerated lesion due to Mycobacterium kansasii. Predisposing factors could have been severe endobronchial stenosis of the main stem bronchi and distortion of the carina, due to healed endobronchial tuberculosis. Diagnosis was set through fiberoptic bronchoscopy and the patient responded well to treatment. Endobronchial non tuberculous mycobacterial infection should be considered in both HIV seropositive and seronegative patients, especially in endemic areas and in the proper clinical setting. Prompt recognition is important for the effective control and prevention of an unfavorable outcome in an otherwise easily treatable disease.

Endobronchial lesions involved in Mycobacterium avium infection

Mycobacterium avium (M. avium) has been described traditionally as an opportunistic organism that causes disseminated disease in the human immunodeficiency virus (HIV)-positive population and that acts as a pulmonary pathogen in patients with underlying lung disease such as chronic obstructive pulmonary disease (COPD) or previously diagnosed tuberculosis. Pulmonary involvement of M. avium may range from asymptomatic colonization of the airway to invasive parenchymal or cavitary disease. However, endobronchial lesions involved in M. avium infection are rare in either immunocompetent or immunosuppressed hosts. We report here endobronchial mycobacterial infection in a HIV-negative patient.

Isolated pulmonary Mycobacterium avium complex infection in patients with human immunodeficiency virus infection: case reports and literature review

We report 4 cases of isolated pulmonary Mycobacterium avium complex (MAC) infection and review the 20 previously reported cases in the human immunodeficiency virus literature. All 4 patients had acquired immune deficiency syndrome, and 3 were believed to have had an immune reconstitution syndrome as a cause of MAC infection. Two patients underwent bronchoscopy with biopsy, revealing endobronchial lesions and granuloma formation, and all 4 patients responded well to MAC therapy.

Pulmonary Mycobacterium avium complex disease without dissemination in HIV-infected patients

Pulmonary disease due to Mycobacterium avium complex (MAC) without evidence of dissemination is uncommon in HIV-infected patients. Five cases were observed over a 2-year period. All patients had AIDS and the median CD4 cell count at the time of presentation was 90 x 10(6)/L. Radiographic patterns included unilobar alveolar infiltrates or diffuse alveolar densities. All patients had a favorable clinical response to antimycobacterial chemotherapy with a median follow-up period of 10 months. MAC should be considered in HIV-infected patients with positive respiratory samples for acid-fast bacilli and pulmonary infiltrates. Patients with such findings in whom presumptive therapy for tuberculosis has failed should receive broad-spectrum antimycobacterial chemotherapy until final identification is available.

Hemoptysis in HIV-infected patients

STUDY OBJECTIVE

To define the causes and clinical features of hemoptysis in HIV-infected patients.

DESIGN

Retrospective analysis of inpatient medical records for patients with HIV infection and hemoptysis.

SETTING

A large New York City teaching hospital and tertiary referral center.

PATIENTS

Fifty HIV-infected adult patients with 51 episodes of hemoptysis.

RESULTS

The incidence of hemoptysis was 1.9%. A definite or presumptive etiology was identified for most (78%) episodes, with infection being the leading cause (80% of episodes with identified etiology). Hemoptysis was most often (40% of episodes with a definite or presumptive etiology) attributed to bacterial pneumonia. Mycobacterium tuberculosis was infrequently the cause of hemoptysis (6%). Mortality attributed to hemoptysis was 8%. In most patients, hemoptysis was mild (77%) and resolved (78%) without specific treatment.

CONCLUSIONS

Our retrospective series of HIV-infected patients hospitalized for short-term care in New York City suggests that hemoptysis in this group has diverse causes but usually is infectious in etiology and most often due to bacterial pneumonia. Bleeding is typically mild and resolves without specific treatment, but can occasionally be fatal. Differential diagnosis should be approached with specific reference to this patient population and its unique features.

[Bronchiectasis associated with human immunodeficiency virus infection]

The precise incidence of bronchiectasis (BCH) in individuals infected by human immunodeficiency virus (HIV) is unknown. Because such knowledge can imply different diagnostic procedures, prognosis and treatment, we report a relevant case in which clinical and radiological signs led to suspicion of BCH which was confirmed by high resolution computerized axial tomography. As life expectancy improves for HIV-infected patients, the incidence of BCH may rise. We therefore believe it is important to include BCH in the spectrum of likely pulmonary radiological signs in the HIV-infected population, though further studies must be done to assess the epidemiology, etiology, pathogenesis and prognosis of BCH.

Endobronchial lesions in HIV-infected individuals

Endobronchial manifestations of HIV infection are rare. The endobronchial appearance and clinical presentation of these lesions may suggest the correct diagnosis. Establishing an appropriate differential diagnosis at the time of visualization of the endobronchial lesion is important because some lesions require specific biopsy techniques or special stains. The bronchoscopist must consider the risks vs benefits of biopsy when confronted with an endobronchial lesion. With the notable exception of pseudomembranous necrotizing tracheobronchial aspergillosis, there are no specific endobronchial lesions associated with HIV infection which increase the risk of complications when they are biopsied. Although EKS is a vascular lesion and an early case report suggested that endobronchial biopsy might result in excessive bleeding, this complication was not observed in two subsequent series. Fortunately, a presumptive diagnosis of EKS can usually be made without biopsy by the characteristic appearance of the lesions. EKS is the most common endobronchial lesion associated with HIV infection; however, its incidence will probably decline as the incidence of KS declines. Many of the other endobronchial lesions described herein have been reported recently. We suspect these and other lesions will be found more frequently, as the epidemic of HIV continues to evolve.

Mycobacterium kansasii presenting as an endobronchial lesion

Four patients underwent bronchoscopy to evaluate a cavitary lesion (one patient), pulmonic infiltrate (two patients), and a lingular mass (one patient). In all cases, an endobronchial obstruction was found. In three cases, forceps biopsy specimens revealed acid-fast bacilli, and all four cultures subsequently yielded only Mycobacterium kansasii. Three of the four patients had AIDS. Endobronchial obstruction has been reported for Mycobacterium tuberculosis and other atypical mycobacteria; however, we believe this to be the first reported series of M. kansasii presenting as an endobronchial obstruction. Unlike the endobronchial lesions seen with M. tuberculosis and other atypical Mycobacterium, the lesions seen with M. kansasii responded favorably to therapy.

The Mycobacterium avium complex

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.

Medical management of AIDS patients. Tuberculosis and nontuberculous mycobacterial disease

AIDS has been responsible for a significant increase in mycobacterial disease, which in this setting is often extrapulmonary. In contrast to HIV-associated Mycobacterium avium complex disease, HIV-associated tuberculosis is normally transmissible between humans by the aerosol route, occurs earlier than most AIDS-related infections, and is readily treatable and preventable with conventional drugs.