Mycobacterium Kansasii Clinical Presentation

  • Author: Janak Koirala, MD, MPH, FACP, FIDSA; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

History

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.[6]

  • Healthy host
    • 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%).[7]
    • Cutaneous M kansasii infection resembles sporotrichosis secondary to local lymphatic spread. Cutaneous lesions may include nodules, pustules, verrucous lesions, erythematous plaques, abscesses, and ulcers.
  • Immunocompromised host
    • 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.
    • M kansasii bacteremia, pericarditis with cardiac tamponade, oral ulcers, chronic sinusitis, osteomyelitis, and scalp abscess have been reported in patients with AIDS.
    • 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.
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Physical

  • Common physical findings of M kansasii infection include the following:
    • Fever
    • Pulmonary crackles and wheezing
    • Lymphadenopathy
  • Analysis of a series of 49 patients coinfected with HIV showed the following physical findings at the time of initial isolation of M kansasii:[8]
    • Pulmonary disease
      • Fever (45%)
      • Lung crackles (40%)
      • Lymphadenopathy (25%)
      • Wheezes (20%)
      • Hepatosplenomegaly (5%)
    • Disseminated disease
      • 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.
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Causes

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.
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Contributor Information and Disclosures
Author

Janak Koirala, MD, MPH, FACP, FIDSA  Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Southern Illinois University School of Medicine

Janak Koirala, MD, MPH, FACP, FIDSA is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, International Society for Infectious Diseases, and International Society of Travel Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Klaus-Dieter Lessnau, MD, FCCP  Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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Chest radiograph in a patient with Mycobacterium kansasii pulmonary infection shows left lower lung infiltrates.
Chest CT scan in a patient with Mycobacterium kansasii pulmonary infection.
Chest radiograph in a patient with classic right upper lobe cavitary lung disease secondary to Mycobacterium kansasii infection. Courtesy of Raj Sreedhar, MD, SIU School of Medicine, Springfield, IL.
CT thorax of a patient with classic right upper lobe cavitary lung disease secondary to Mycobacterium kansasii infection. Courtesy of Raj Sreedhar, MD, SIU School of Medicine, Springfield, IL.
 
 
 
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