CLINICAL AND RADIOGRAPHIC MANIFESTATIONS OF UNCOMMON PULMONARY NONTUBERCULOUS MYCOBACTERIAL DISEASE IN AIDS PATIENTS

Study objective: To determine the clinical and radiographic findings o f nontuberculous mycobacteria (NTM) other than Mycobacterium avium com plex (MAC) and Mycobacterium kansasii in AIDS compared with non-AIDS p atients. Design: A retrospective chart review of all patients in whom NTM other than MAC complex: and M kansasii were isolated between April 1, 1989, and October 31, 1995. Setting: University-affiliated hospita l, Patients: Fifty-four patients met the criteria for uncommon pulmona ry NTM disease: (1) repeated isolation of atypical mycobacterium in co lony counts of greater than or equal to 3 from two ok more sputum spec imens; or isolation of the organism from transbronchial or open lung b iopsy specimen with histologic changes suggestive of mycobacterial dis ease in the absence of other pathogens; and (2) either an abnormal che st radiograph, the cause of which had not been attributed to an active infection other than atypical mycobacterial disease; or the presence of one or more symptoms indicative of pulmonary disease coupled with e xclusion of other illnesses with similar symptoms and signs. Results: Thirty-five patients were HIV positive. Fever was the only clinical sy mptom more commonly seen in HIV-infected patients with NTM than non-HI V-infected patients. Sixty-six percent of all patients with AIDS were infected by Mycobacterium xenopi. Chest radiographs of AIDS patients s howed a tendency for predominance of interstitial infiltrate and rarit y of fibronodular disease, No specific radiographic pattern was observ ed for any particular organism. Adenopathy was not a feature of uncomm on pulmonary NTM in AIDS, and it should suggest an alternate diagnosis . In two patients, NTM isolation from respiratory specimens preceded d issemination, Six of 8 AIDS patients treated for pulmonary NTM remaine d alive at the end of the study compared with only 4 of 15 patients wh o were not treated for pulmonary NTM (p<0.05). Conclusions: Uncommon N TM isolated from respiratory specimens ought to be considered as serio us pathogens in the presence of clinical and radiographic manifestatio ns unexplained by other pathologic processes. Colonization with NTM co uld precede dissemination. Treatment of uncommon pulmonary NTM disease could possibly confer a survival benefit in AIDS patients.