Infection with the Mycobacterium avium complex in patients without predisposing conditons: a case report and literature review

Nontuberculous Mycobacteria (NTM), especially Mycobacterium avium-intracellulare complex (MAC), has been considered responsible for human disease, especially in HIV patients. Nevertheless, it has been diagnosed in immunocompetent elderly men, frequently with previous pulmonary disease: chronic obstructive lung disease (COPD), complications of tuberculosis, pulmonary fibrosis and bronchiectasis. We relate the case of a female patient, 51 years old, with continuously acid fast bacilli (AFB) smears and with three previous treatments, which were conducted at the multiresistant tuberculosis (MRTB) service. MAC was identified in the sputum culture, and she received treatment for one year. The posterior sputum exams were negative. The cavity lesions observed in the high-resolution computed tomography (HRCT) were reduced, and some of the nodule lesions became bronchiectasis, even after the end of treatment. We agree with the literature reports that indicate that MAC is the cause of bronchiectasis. It is necessary to identify the type of mycobacteria in immunocompetent individuals with positive AFB smears that do not become negative with tuberculosis treatment.

Nontuberculosis mycobacteria at a multiresistant tuberculosis reference center in Bahia: clinical epidemiological aspects

OBJETIVO: Examine the prevalence and clinical/epidemiological aspects of patients with nontuberculous mycobacteria (NTM) isolated from sputum provided by an outpatient clinic specializing in the treatment of multiresistant tuberculosis (MRTB) in Bahia, Brazil. METHODS: All patients followed at the MRTB outpatient clinic of the Octávio Mangabeira Specialized Hospital (HEOM) were evaluated retrospectively from July 1998 to July 2003. All patients underwent direct examinations and cultures to identify the mycobacteria species found during initial and subsequent evaluations. The following variables were recorded: age, gender, clinical symptoms and signs, pre-existing lung disease, prior TB treatment, HIV serology, and NTM species. Categorical and quantitative variables were respectively characterized using proportions and measures ± SD. RESULTS: NTM were isolated in 19 of 231 patients (8.2 percent; 95 percentCI: 5.2 percent-12.3 percent), with the following species distribution: 58 percent (11/19) M. chelonae/abscessus; 16 percent (3/19) M. avium-intracellular complex; 16 percent (3/19) M. kansasii; and 11 percent (2/19) M. fortuitum. HIV serology was positive for just one patient (5 percent), from whom M. chelonae/abscessus was isolated. Productive coughing was observed in all cases. American Thoracic Society (ATS) diagnostic criteria for NTM lung disease were observed in 14 patients (74 percent). CONCLUSION: The prevalence of NTM isolated from patients referred to the MRTB outpatient clinic in Bahia was 8.2 percent (CI 95 percent: 5.2 percent-12.3 percent); rapid-growth mycobacteria (M. chelonae/M. fortuitum) were the most frequently isolated (68 percent).

Fibrose cística em adultos: aspectos clínicos e espirométricos / Cystic fibrosis in adults clinical and spirometric aspects

INTRODUÇAO: A fibrose cística é diagnosticada usualmente na infância. No Brasil, poucos estudos abordam seu diagnóstico na idade adulta. OBJETIVO: Descrever as características demográficas, clínicas e os achados de espirometria dos pacientes com fibrose cística diagnosticados na idade adulta, na Bahia (Brasil). MÉTODO: Foram avaliados 28 pacientes com fibrose cística diagnosticada na idade adulta no Centro de Referência de Fibrose Cística do Estado da Bahia. As variáveis de interesse foram: idade, gênero, cor, índice de massa corpórea (IMC), cultivo do escarro, porcentagem do previsto da capacidade vital forçada ( por cento CVF), porcentagem do previsto do volume expiratório forçado no primeiro segundo ( por cento VEF1) e resposta ao broncodilatador. RESULTADOS: A média de idade dos pacientes foi de 31,1±12,4 anos. A proporção de negros e mulatos foi de 53,7 por cento, e a média de IMC foi 18,7±3,0Kg/m2. Em doze pacientes (43 por cento) foi confirmada P. aeruginosa no escarro. As médias ±DP dos percentuais do previsto da CVF e do VEF1 foram de 58,9±21,6 por cento e 44,1±23 por cento respectivamente. No grupo colonizado por P. aeruginosa as médias dos parâmetros espirométricos foram inferiores às do grupo não colonizado. Entretanto, somente em relação à CVF esta diferença alcançou significância estatística (p= 0,007). CONCLUSAO: Concordante com a literatura, este estudo reforça que o diagnóstico de fibrose cística deve ser investigado em pacientes com infecções respiratórias de repetição, sinusite e bronquiectasias, mesmo na idade adulta. Os valores dos percentuais da CVF e VEF1 em relação ao previsto foram menores nos pacientes colonizados por P aeruginosa, evidenciando uma maior deterioração da função pulmonar.

Prevalence of pathogens in cystic fibrosis patients in Bahia, Brazil

INTRODUCTION: Recurrent respiratory infections account for most of the morbidity and mortality of cystic fibrosis patients. MATERIALS AND METHODS: The objective was to determine the prevalence of pathogens isolated from lower respiratory tract secretions in cystic fibrosis patients. In this descriptive observational study, data from 69 patients was collected from medical records. RESULTS: The microorganisms that were identified included 36.2 percent P. aeruginosa, 28.9 percent S. Aureus, 4.3 percent K. pneumoniae, 1.5 percent H. influenzae, 1.5 percent E. coli, 1.5 percent S. maltoophilia, and in 27.5 percent the flora was normal. The prevalence of P. aeruginosa was 83 percent in patients under two years of age, demonstrating early colonization. CONCLUSION: P. aeruginosa and S. aureus were the most prevalent pathogens; there was also early infection/colonization by P. aeruginosa. This information will contribute to improved therapeutic measures for patients of the Bahia Cystic Fibrosis Reference Center

Clinical and radiological analysis of children and adolescents with tuberculosis in Bahia, Brazil

We reviewed the clinical and radiological characteristics of tuberculosis (TB) in children and adolescents at the Hospital Especializado Octávio Mangabeira, (HEOM) in Salvador, Bahia. This study included 275 TB patients aged 1 to 15 years seen between January 1990 and November 2001. Standardized forms were filled out on the basis of a review of patient records and x-rays. Through a retrospective and descriptive analysis, it was found that 51.6 percent were male, 35.3 percent were aged 1 to 5 years, 28 percent were aged 6 to 10 and 36.7 percent were aged 11 to 15. Among all patients, 79.6 percent lived in the city of Salvador. A history of contact with TB was found in 63.9 percent, most frequently among children under 5 years old; 77.2 percent were vaccinated with Bacillus Calmette-Guerin (BCG). The most frequently observed symptoms were coughing (76 percent), fever (73.1 percent) weight loss (53.1 percent), and 4.7 percent were asymptomatic. Pulmonary TB was most frequent (57.8 percent) and extra-pulmonary TB occurred in 24.4 percent, with a predominance of hilar adenopathy. Both forms occurred simultaneously in 17.8 percent. In 53.1 percent of the cases the diagnosis was not determined by bacteriology or pathological anatomy; in these cases diagnosis was reached through clinical and radiological criteria, contact history, a tuberculin test >10mm and a positive response to tuberculostatic drugs