B. Grinsztejn et al., MYCOBACTEREMIA IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME, Archives of internal medicine, 157(20), 1997, pp. 2359-2363
Background: Bacillemia is a key event in the pathogenesis of tuberculo
sis. Although current evidence indicates that Mycobacterium tuberculos
is bacteremia is rare in patients seronegative for the human immunodef
iciency virus, it has been increasingly reported in patients with the
acquired immunodeficiency syndrome (AIDS). Objective: To determine cli
nical and laboratory characteristics of patients with AIDS and tubercu
losis with and without bacillemia. Methods: Fifty patients with AIDS w
ith clinical suspicion of disseminated mycobacterial disease were pros
pectively selected. Three consecutive blood samples were collected for
culture using a standardized protocol. Results: Mycobacterium was iso
lated from any body site in 42 patients (84%). Bacillemia was detected
in 30 (71.4%) of these 42 patients: 11 (28.2%) caused by Mycobacteriu
m avium-intracellulare complex and 19 (71.8%) caused by M tuberculosis
. Blood culture was the only method used to confirm the diagnosis in 5
(15%) of the 33 tuberculosis cases. Tuberculosis in patients with AID
S developed with nonspecific insidious symptoms, a remarkable elevated
alkaline phosphatase level, and without the classic miliary radiologi
cal pattern. We could demonstrate 2 previously unrevealed clinical cha
racteristics of bacteremic tuberculosis in patients with AIDS: a shift
to the left in the white blood cell count and abdominal lymph node en
largement. In patients with tuberculosis, the in-hospital mortality ra
te was higher among patients with bacillemia, although the posttreatme
nt survival rate was comparable. Conclusions: Blood culture is a valua
ble tool to confirm the clinical diagnosis of disseminated tuberculosi
s in patients with AIDS and can distinguish patients with characterist
ic clinical findings and outcome. Abdominal ultrasonography may be an
additional helpful tool to identify these patients.