Mycobacterium Kansasii Clinical Presentation
- Author: Janak Koirala, MD, MPH, FACP, FIDSA; Chief Editor: Mark R Wallace, MD, FACP, FIDSA more...
In most cases, M kansasii causes lung disease that is clinically indistinguishable from tuberculosis. Symptoms may be less severe and more chronic than Mycobacterium tuberculosis infection. Asymptomatic M kansasii infection occurs in a small proportion (16%) of affected patients.
The most common symptoms of pulmonary M kansasii infection include cough (91%), sputum production (85%), weight loss (53%), breathlessness (51%), chest pain (34%), hemoptysis (32%), and fever or sweats (17%).
Cutaneous M kansasii infection resembles sporotrichosis secondary to local lymphatic spread. Cutaneous lesions may include nodules, pustules, verrucous lesions, erythematous plaques, abscesses, and ulcers.
M kansasii infection manifests late in the course of HIV disease. The lung is the organ most commonly involved. Commonly reported symptoms include fever, chills, night sweats, productive or nonproductive cough, weight loss, fatigue, dyspnea, and chest pain.
Almost 20% of patients with HIV infection who develop M kansasii infection eventually develop disseminated disease.
M kansasii meningitis similar to M tuberculosis meningitis has been reported in patients infected with HIV and may carry a higher mortality rate despite appropriate antibiotic therapy.
Disseminated M kansasii infection has also been reported in other immunocompromised hosts (eg, patients with myelodysplastic syndrome, patients on hemodialysis).
Cutaneous M kansasii infections in immunocompromised hosts usually have atypical clinical features (eg, cellulitis, seroma). These features, along with atypical histology (eg, absence of granuloma), may delay diagnosis.
Common physical findings of M kansasii infection include the following:
Pulmonary crackles and wheezing
Analysis of a series of 49 patients coinfected with HIV showed the following physical findings at the time of initial isolation of M kansasii:
- Fever (45%)
- Lung crackles (40%)
- Lymphadenopathy (25%)
- Wheezes (20%)
- Hepatosplenomegaly (5%)
- Fever (60%)
- Hepatosplenomegaly (40%)
- Lung crackles (25%)
- Lymphadenopathy (10%)
- Cutaneous lesions (10%)
- Wheezes (5%)
Patients with cutaneous M kansasii infection may develop nodules, pustules, verrucous lesions, erythematous plaques, abscesses, or ulcers.
Other signs depend on the site of infection or dissemination.
Immunocompromised patients, including patients with HIV/AIDS, are at a high risk for M kansasii infection.
Predisposing conditions for M kansasii infection include pulmonary conditions resulting from pneumoconioses (especially silicosis, gold mining, and coal mining), healed chronic infections (eg, tuberculosis, mycosis, chronic obstructive pulmonary disease, bronchiectasis), heavy smoking, and chronic obstructive pulmonary disease.
Other risk factors include cancer, diabetes mellitus, long-term steroid use, alcoholism, peptic ulcer disease, coronary artery disease, and prior pneumonia.
Han SH, Kim KM, Chin BS, Choi SH, Lee HS, Kim MS, et al. Disseminated Mycobacterium kansasii infection associated with skin lesions: a case report and comprehensive review of the literature. J Korean Med Sci. 2010 Feb. 25(2):304-8. [Medline]. [Full Text].
Bloch KC, Zwerling L, Pletcher MJ. Incidence and clinical implications of isolation of Mycobacterium kansasii: results of a 5-year, population-based study. Ann Intern Med. 1998 Nov 1. 129(9):698-704. [Medline].
Sheu LC, Tran TM, Jarlsberg LG, Marras TK, Daley CL, Nahid P. Nontuberculous mycobacterial infections at San Francisco General Hospital. Clin Respir J. 2014 May 6. [Medline].
Corbett EL, Churchyard GJ, Hay M. The impact of HIV infection on Mycobacterium kansasii disease in South African gold miners. Am J Respir Crit Care Med. 1999 Jul. 160(1):10-4. [Medline].
Evans AJ, Crisp AJ, Hubbard RB. Pulmonary Mycobacterium kansasii infection: comparison of radiological appearances with pulmonary tuberculosis. Thorax. 1996 Dec. 51(12):1243-7. [Medline].
Hoefsloot W, van Ingen J, Andrejak C, Angeby K, Bauriaud R, Bemer P, et al. The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study. Eur Respir J. 2013 Dec. 42(6):1604-13. [Medline].
Maliwan N, Zvetina JR. Clinical features and follow up of 302 patients with Mycobacterium kansasii pulmonary infection: a 50 year experience. Postgrad Med J. 2005. 81:530-33. [Medline].
Evans SA, Colville A, Evans AJ. Pulmonary Mycobacterium kansasii infection: comparison of the clinical features, treatment and outcome with pulmonary tuberculosis. Thorax. 1996 Dec. 51(12):1248-52. [Medline].
Witzig RS, Fazal BA, Mera RM. Clinical manifestations and implications of coinfection with Mycobacterium kansasii and human immunodeficiency virus type 1. Clin Infect Dis. 1995 Jul. 21(1):77-85. [Medline].
Gail L. Woods, M.D. et al. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes; Approved Standard. Second Edition. Wayne, PA: Clinical and Laboratory Standards Institute; 2011. M24A2:
Woods GL. Susceptibility testing for mycobacteria. Clin Infect Dis. 2000. 31:1209-1. [Medline].
Smith MB, Molina CP, Schnadig VJ. Pathologic features of Mycobacterium kansasii infection in patients with acquired immunodeficiency syndrome. Arch Pathol Lab Med. 2003. 127:554-60. [Medline].
American Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med. 1997 Aug. 156(2 Pt 2):S1-25. [Medline].
Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007 Feb 15. 175(4):367-416. [Medline].
Griffith DE. Management of disease due to Mycobacterium kansasii. Clin Chest Med. 2002. 23:613-21. [Medline].
Hombach M, Somoskövi A, Hömke R, Ritter C, Böttger EC. Drug susceptibility distributions in slowly growing non-tuberculous mycobacteria using MGIT 960 TB eXiST. Int J Med Microbiol. 2013 Jul. 303(5):270-6. [Medline].
Wu TS, Leu HS, Chiu CH, Lee MH, Chiang PC, Wu TL, et al. Clinical manifestations, antibiotic susceptibility and molecular analysis of Mycobacterium kansasii isolates from a university hospital in Taiwan. J Antimicrob Chemother. 2009 Sep. 64(3):511-4. [Medline].
Brown-Elliott BA, Nash KA, Wallace RJ Jr. Antimicrobial susceptibility testing, drug resistance mechanisms, and therapy of infections with nontuberculous mycobacteria. Clin Microbiol Rev. 2012 Jul. 25(3):545-82. [Medline]. [Full Text].
Guna R, Munoz C, Dominguez V. In vitro activity of linezolid, clarithromycin and moxifloxacin against clinical isolates of Mycobacterium kansasii. J Antimicrob Chemother. 2005. 55:950-53. [Medline].
Marras TK, Morris A, Gonzalez LC. Mortality prediction in pulmonary Mycobacterium kansasii infection and human immunodeficiency virus. Am J Respir Crit Care Med. 2004. 170:793-98. [Medline].
Mitha M, Naicker P, Taljaard J. Cutaneous Mycobacterium kansasii infection in a patient with AIDS post initiation of antiretroviral therapy. J Infect Dev Ctries. 2011 Jul 27. 5(7):553-5. [Medline].
Alcaide F, Benitez MA, Martin R. Epidemiology of Mycobacterium kansasii. Ann Intern Med. 1999 Aug 17. 131(4):310-1. [Medline].
Breathnach A, Levell N, Munro C. Cutaneous Mycobacterium kansasii infection: case report and review. Clin Infect Dis. 1995 Apr. 20(4):812-7. [Medline].
Davidson PT. The diagnosis and management of disease caused by M. avium complex, M. kansasii, and other mycobacteria. Clin Chest Med. 1989 Sep. 10(3):431-43. [Medline].
Fishman JE, Schwartz DS, Sais GJ. Mycobacterium kansasii pulmonary infection in patients with AIDS: spectrum of chest radiographic findings. Radiology. 1997 Jul. 204(1):171-5. [Medline].
O'Brien RJ. The epidemiology of nontuberculous mycobacterial disease. Clin Chest Med. 1989 Sep. 10(3):407-18. [Medline].
Wolinsky E. Mycobacterial diseases other than tuberculosis. Clin Infect Dis. 1992 Jul. 15(1):1-10. [Medline].
Woods GL, Meyers WM. Mycobacterial Diseases. Damjanov I, Linder J, eds. Anderson's Pathology. St. Louis, Mo: Mosby; 1996. Vol 10: 843-55.