HUMAN IMMUNODEFICIENCY VIRUS-ASSOCIATED ATYPICAL MYCOBACTERIAL SKELETAL INFECTIONS

The clinical and laboratory features of six human immunodeficiency vir us (HIV)-positive patients with atypical mycobacterial skeletal infect ions, seen at a county outpatient HIV facility or university outpatien t clinic, are reviewed and compared with other reported cases. Atypica l mycobacterial skeletal infections are a manifestation of advanced HI V disease, with most cases having CD4 counts <100/mm(3) at the time th ese infections become clinically apparent. Multiple sites are frequent ly involved, and concomitant skin infection with the same organism is common, especially with Mycobacterium haemophilum. The incidence of at ypical mycobacterial skeletal infection in HIV-infected individuals wa s significantly higher than in the general county hospital district pa tient population, whereas the frequency of Myobacterium tuberculosis s keletal infection did not differ significantly between the two populat ions. The clinician therefore should maintain a high index of suspicio n for atypical mycobacteria in a patient presenting with skeletal infe ction in the setting of a markedly depressed CD4 count. (C) 1996 by W. B. Saunders Company