Quadruple-drug therapy for Mycobacterium avium-intracellulare bacteremia in AIDS patients

Article Abstract:

Human immunodeficiency virus (HIV) is the causative agent of acquired immune deficiency syndrome (AIDS). Patients with AIDS have suppressed immune systems and are thus prone to opportunistic infections, such as by Mycobacterium avium-intracellulare complex (MAC). Symptoms of MAC infection include sweats, fever, lethargy, cough, abdominal pain and headache. Since MAC is resistant to many different antibacterial agents, drug treatment protocols have been redesigned to include a multiple drug approach. Rifabutin and clofazimine are commonly used and are effective in treating certain strains of MAC. A quadruple drug therapy program for the treatment of AIDS patients with MAC was initiated at the Fairfield Infectious Diseases Hospital in Melbourne, Australia. The treatment regimen included isoniazid, ethambutol, clofazimine and rifabutin. Blood samples were analyzed for the presence of Mycobacterium. Prior to drug treatment, all of the patients had reduced numbers of T-lymphocytes (cells that stimulate antibody production) in their blood, indicating that patients were immunodeficient. In 22 out of 25 patients, the Mycobacterium infection disappeared and did not return during a four-week follow-up period. In 16 out of 25 patients, the infection disappeared and did not return for up to 72 weeks. MAC isolated from blood samples was resistant to clofazimine, isoniazid and ethambutol when these drug were tested individually. Sixteen of 24 MAC samples isolated from blood were resistant to rifabutin. It is concluded that the quadruple drug treatment protocol used in this study appears to be effective in clearing mycobacteremia and in alleviating the symptoms associated with infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Antibiotics, Development and progression, Drug therapy, Drug resistance in microorganisms, Microbial drug resistance, Dosage and administration, Opportunistic infections

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Mycobacterium avium and Mycobacterium intracellulare infections in patients with and without AIDS

Article Abstract:

After Mycobacterium tuberculosis, M. avium and M. intracellulare, the Mycobacterium avium complex (MAC), are the mycobacterial strains most commonly isolated in the clinical laboratory. They are usually obtained from obstructive lung disease and nontuberculosis pulmonary disease. The clinical significance of MAC has substantially increased because of acquired immunodeficiency syndrome (AIDS), and the bacteria are frequently recovery from sites outside the pulmonary system, including the brain. Biologically the MAC strains are virtually indistinguishable. Most strains are resistant to the effects of any but the most potent chemotherapeutic agents. The epidemiology and distribution of MAC infections within both the AIDS and non-AIDS populations were the focus of this study. The study population of 154 persons was drawn from California and New York. Forty-five subjects had AIDS and were clinically infected with MAC, with isolations from various sites, including lungs, blood, liver, bone marrow, and brain. The remaining 109 non-AIDS cases were either infected with or colonized with MAC of pulmonary origin. Species-specific genetic probes were used to define the isolates. M. avium species were most frequently isolated from AIDS or ARC (AIDS-related complex) cases, while M. intercellulare species were common in the non-AIDS cases. The latter strains showed greater susceptibility to the antibiotics streptomycin, rifampin and ethambutol, and resistance to ethionamide. The significance of the differences in the disease spectrum and antibiotic susceptibility patterns requires further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Genetic aspects, Mycobacteria, Mycobacterium, AIDS-related complex

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Absence of bacteremia with Mycobacterium avium-intracellulare in Ugandan patients with AIDS

Article Abstract:

Mycobacterium avium-intracellulare (MAI) used to be a relatively rare form of pneumonia in the United States. It was mainly associated with chronic lung disease. With the development of acquired immunodeficiency syndrome (AIDS), MAI infections have become more common. MAI is now recognized as the most common cause of systemic bacterial infection in AIDS patients in the United States. The prevalence of MAI infection varies from one geographic region to another. The occurrence of MAI infection does not appear to be related to gender, age, race or sexual preference. Symptoms of MAI infection include loss of appetite, weight loss, weakness, fever, diarrhea and abdominal pain. Blood cultures are the common method for diagnosing MAI, since blood samples of patients with MAI have large amounts of bacteria. To better understand the geographic influences of MAI infection, the prevalence of MAI was determined in AIDS patients living in Uganda. Blood samples from 50 severely ill Ugandan AIDS patients were analyzed for the presence of MAI. Blood samples were analyzed at the national reference laboratory for mycobacteria. All 50 blood samples were negative for MAI. These findings indicate that MAI infection is not common in AIDS patients in Uganda. (Consumer Summary produced by Reliance Medical Information, Inc.)

Uganda, Mycobacterial infections, Mycobacterium infections

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