COINFECTION BY CRYPTOCOCCUS-NEOFORMANS AND MYCOBACTERIUM-AVIUM-INTRACELLULARE IN AIDS - CLINICAL AND EPIDEMIOLOGIC ASPECTS

In the observation of various opportunistic pathogens in HIV-positive persons, co-infection by Cryptococcus neoformans together with Mycobac terium avium intracellulare was found if there was a CD4 lymphocyte co unt as low as 3-20/mu l. In 1540 HIV-positive patients under treatment at a Berlin hospital (Auguste-Viktoria-Krankenhaus) during 1985-1994, all AIDS-relevant diseases were examined in a multivariate analysis a s variables of influence on the manifestation of a systemic Mycobacter ium avium complex (MAC) infection. The analysis involved data on 36 ca ses of cryptococcosis and 202 cases with a typical clinical course in whom MAC had been detected at sterile body sites. As significant and i ndependent factors of influence, the following were identified: C. neo formans infection, wasting syndrome, lower age, low CD4 lymphocyte cou nt and preceding Pneumocystis carinii pneumonia (PcP) prophylaxis. Cry ptococcosis ranged first with an odds ratio of 2.75. The concomitant m anifestation of cryptococcosis and systemic MAC infection in six patie nts is shown. Because both opportunists, C. neoformans and avian mycob acteria, may have their common habitat in droppings of defined species of pet birds, a common source of infection deserves further clinical and epidemiological attention.