CLINICAL AND EPIDEMIOLOGIC FEATURES OF INFECTION WITH MYCOBACTERIUM GENAVENSE

Objectives: To characterize clinical and epidemiologic features of inf ections with Mycobacterium genavense. Design: Case series and case-con trol studies. Patients with M genavense were compared with two control groups: CD4 controls were matched on the basis of CD4 counts, and Myc obacterium avium-intracellulare complex controls had disseminated infe ction with M avium-intracellulare complex. Results: Fifty-four patient s with disseminated infections caused by M genavense were found, from Europe (37), North America (15), and Australia (two). All were infecte d with human immunodeficiency virus. The median CD4 count was 0.016 x 10(9)/L (16/mm(3)) (range, 0.001 to 0.082 x 10(9)/L). Eighty-seven per cent had fever and weight loss, 44% had diarrhea, 43% had splenomegaly , 39% had hepatomegaly, and 72% had anemia. In Swiss university hospit als, M genavense was responsible for 12.8% of nontuberculous dissemina ted mycobacterial infections in patients with human immunodeficiency v irus from 1990 to 1992. The median survival was 190 days after the fir st isolation of M genavense. Among the patients who had been treated w ith at least two antimycobacterial drugs for 1 month or more, median s urvival was 263 days (95% confidence interval, 144 to 382 days), compa red with 81 days (95% confidence interval, 73 to 89 days) for those no t treated (P=.0009). Survival in patients with M genavense was similar to the survival of M avium-intracellulare complex controls. However, patients with similar CD4 counts (CD4 controls) survived longer (media n, 342 days; 95% confidence interval, 269 to 415 days; P<.0003). Concl usions: Infection with M genavense may be responsible for more than 10 % of disseminated nontuberculous mycobacterial infections in patients with human immunodeficiency virus infection. Its clinical presentation and response to treatment are similar to those of infection with M av ium-intracellulare complex.