MYCOBACTERIUM-KANSASII PULMONARY INFECTION IN PATIENTS WITH AIDS - SPECTRUM OF CHEST RADIOGRAPHIC FINDINGS

PURPOSE: To determine the chest radiographic findings and clinical man ifestations of Mycobacterium kansasii pulmonary infection in patients with acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Criteria for diagnosis included two or more positive cultures from re spiratory sources, pulmonary symptoms or fever, and no other identifia ble cause of pulmonary disease. Chest radiographs at initial examinati on and follow-up were evaluated for parenchymal opacities, cavitation, adenopathy, and pleural effusions. Medical records were reviewed for clinical signs and symptoms, CD4 cell count, presence of additional pa thogens, and response to antimycobacterial therapy. RESULTS: Of 96 pat ients, 16 (17%) satisfied all criteria for M kansasii pulmonary infect ion. The mean CD4 cell count was 24/mm(3). Twelve patients (75%) demon strated alveolar opacities, only three (19%) of which were cavitary. I nterstitial opacities (6%) and pleural effusions (12%) were uncommon. Four (25%) patients had thoracic lymphadenopathy, which was the only p ositive radiographic finding in two patients. Fourteen patients were t reated for M kansasii, and 10 (71%) showed clinical and radiographic i mprovement. CONCLUSION: Patients with AIDS and pulmonary M kansasii fr equently demonstrate focal alveolar opacities. Symptomatic patients wi th pulmonary nontuberculous mycobacteria should be presumptively treat ed for pulmonary M kansasii until final culture results are available.