Subject(s)
Disease Susceptibility , Interleukin-12 Receptor beta 1 Subunit/deficiency , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/etiology , Mycobacterium xenopi , Adult , Genetic Predisposition to Disease , Humans , Mycobacterium xenopi/immunologyABSTRACT
We present the case of a 6-year-old, immunocompetent boy with chronic osteomyelitis of the calcaneus caused by Mycobacterium xenopi. Of note, typical histopathology was not visible on the first biopsy and developed only later over a period of 6 weeks, highlighting the difficult differential diagnosis of osteomyelitis caused by nontuberculous mycobacteria.
Subject(s)
Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium xenopi , Osteomyelitis/diagnosis , Osteomyelitis/microbiology , Anti-Bacterial Agents/therapeutic use , Biopsy , Child , Humans , Magnetic Resonance Imaging , Male , Mycobacterium Infections, Nontuberculous/therapy , Mycobacterium xenopi/classification , Mycobacterium xenopi/immunology , Osteomyelitis/drug therapy , Treatment OutcomeSubject(s)
HIV Infections/complications , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/immunology , Mycobacterium xenopi/drug effects , Mycobacterium xenopi/immunology , Respiratory Tract Infections/immunology , Respiratory Tract Infections/microbiology , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/immunology , Anti-Bacterial Agents/therapeutic use , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Humans , Immunity, Innate/drug effects , Mycobacterium Infections, Nontuberculous/complicationsABSTRACT
OBJECTIVE: Unusual clinical inflammatory syndromes associated with underlying previously unrecognized opportunistic infections are increasingly being noted shortly after starting highly active antiretroviral therapy (HAART). This study examined the possible relationship between such unexpected disease manifestations and in vitro parameters of microbial antigen-specific immune reactivity in patients infected with HIV-1 who had a Mycobacterium avium intracellulare or Mycobacterium xenopi infection. DESIGN: In vitro T-cell proliferation experiments were performed after specific stimulation of a patient's peripheral blood mononuclear cells (PBMC) with M. avium and M. xenopi antigen and non-specific stimulation with phytohaemagglutinin (PHA). The results were compared with appropriate controls. PATIENTS: Five patients who presented with unusual clinical syndromes associated with M. avium or M. xenopi infection within weeks of experiencing large rises in CD4+ cell counts following the initiation of antiretroviral therapy. RESULTS: In all patients except one, mycobacteria-specific lymphoproliferative responses rose significantly following HAART; this was temporally associated with elevations in CD4+ cell counts and the occurrence of clinical disease. The patient with M. xenopi infection appeared to clear his infection subsequently without antimycobacterial therapy. In three of the four patients with M. avium infection, antimycobacterial treatment could be stopped without recurrence of infection. CONCLUSION: Our findings support the hypothesis that HAART may lead to clinically relevant inflammation as a result of restoration of specific immune reactivity against microbial pathogens that are subclinically present at the time treatment is initiated. Continuation of HAART may subsequently result in protective immunity and clearance of infection.
