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Atypical Mycobacterial Infection Clinical Presentation

  • Author: Arry Dieudonne, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Jan 07, 2015
 

History

Suppurative cervical or submandibular lymphadenopathy that produces or does not produce systemic symptoms is the most common presentation of atypical mycobacterial infection caused by M avium-intracellulare and M scrofulaceum in the immunocompetent pediatric host. In a cohort of children infected with HIV prospectively monitored by Hoyt et al in 1992, recurrent and persistent fever and chronic anemia were the most common signs and symptoms, followed by chronic diarrhea and a history of recurrent abdominal pain with disseminated M avium complex (MAC) disease[38, 40, 41]

Weight loss, failure to gain weight, and wasting syndrome are part of the long-term presentations of disseminated MAC disease in immunocompromised children. Other signs and symptoms include leukopenia, hepatosplenomegaly, and persistent generalized lymphadenopathies. Ulcerative lesions of the colon and mesenteric disease with abscess formation have been reported.[41, 42, 43] Primary cutaneous infections with MAC are rare; most cases are caused by dissemination, with manifestations including scaling plaques, crusted ulcers, ecthymalike lesions, verrucous ulcers, inflammatory nodules, panniculitis, pustular lesions, and draining sinuses.[44]

Buruli ulcer is a chronic ulcerative skin disease, caused by M ulcerans, that mostly affects the limbs. The lack of acute inflammatory response is typical and is likely due to an immunosuppressive toxin called mycolactone, which is produced by mycobacteria.[26, 25] Buruli ulcer mainly affects children living in humid areas of the tropical rain forest. Following a microinjury, the organism penetrates the skin. A subcutaneous nodule develops a few weeks later, followed by necrosis of the subcutaneous fat and finally by a large dermal ulceration. Constitutional symptoms are normally absent.

Atypical mycobacteria may cause skeletal infections. A large outbreak of spinal infections after discovertebral surgery was reported in 2001.[45] Tenosynovitis, multifocal osteomyelitis, septic arthritis, protracted carpal tunnel syndrome, and spondylitis implicating M chelonae, Mycobacterium kansasii, MAC, or Mycobacterium xenopi have been described in the literature.[46, 47, 48, 49, 50] Keratitis and endophthalmitis after intravitreous injection of steroids or other ophthalmoscopic procedures secondary to M chelonae invasion have been reported. Although most of those infections secondary to atypical mycobacteria have been described in the adult population, cases of cutaneous mycobacteriosis manifesting as cellulitis, skin abscess, or sporotrichoid lesions secondary to M chelonae abscessus and M kansasii have been reported. M kansaii and M marinum have been reported in aquariumworkers.[51, 52] M avium– associatedtyphlitis mimicking appendicitis has been described in an immunocompetent host.[53]

Catheter-related infections are the most common nosocomial nontuberculous mycobacterial infections encountered. The fast-growing atypical mycobacteria, such as M fortuitum, cause most catheter-related infections. Patients with long-term central intravenous catheters are most susceptible. However, infections have occurred in patients with peritoneal and shunt catheters. Local catheter site drainage; tunnel infections; and mycobacteremia, with or without fever, are the usual manifestations, but granulomatous hepatitis and, sometimes, pulmonary infiltrates have been observed. Case reports of atypical mycobacterial infection in transplant patients due to M chelonae and M xenopi have been described in the medical literature.[54, 55]

Wright et al report 18 cases of infection associated with laparoscopic gastric banding caused by Mycobacterium fortuitum and M. abscessus in Australia during 2005–2011. The authors identified cases by reviewing positive cultures at the Queensland state reference laboratory or through correspondence with clinicians, and obtained clinical and epidemiologic data. Eleven cases of M. fortuitum and 7 cases of M. abscessus infection were identified. The port was thought to be the primary site of infection in 10 of these cases. Complications included peritonitis, band erosion, and chronic ulceration at the port site. Rapidly growing mycobacteria can infect both port and band and can occur as either an early perioperative or late infection. Combination antimicrobial therapy is used on the basis of in vitro susceptibilities. The authors concluded that device removal seemed to be vital to successful therapy.[56, 57]

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Physical

Immunocompetent children with adenitis secondary to MAC present with suppurative adenitis that may or may not produce constitutional symptoms such as fever. Fistula may be present with coalescence of involved cervical or mandibular nodes. In immunocompromised children with HIV/AIDS, no pathognomonic signs are present. Physical examination may reveal that a debilitated patient has a history of failure to gain weight, chronic fatigue, chronic diarrhea, and recurrent abdominal pain. Hepatosplenomegaly may be present. Early during disseminated MAC disease, some patients may not have fever and may not appear acutely or chronically ill.[58]

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Causes

Numerous atypical mycobacterial infections are known. The most common forms of diseases are chronic pulmonary disease resembling tuberculosis (occurring mainly in adults), cervical adenopathy in children, skin and soft tissue infections, and disseminated disease in immunocompromised persons.[7, 16] Lymphadenitis is the most common manifestation in children.[7, 23] However, progressive immunodeficiency due to infection with HIV appears to be the most significant factor for disseminated MAC disease.[59, 16, 60]

A unique MAC syndrome that develops in patients with AIDS in the first 1-2 months following the initiation of HAART has been described by 3 groups of investigators.[61, 62, 63, 64] The symptom consists of fever and focal MAC lymphadenitis, with a blood culture negative for mycobacteria in most cases. The symptom is also known as immune reconstitution syndrome. It may occur in patients who already had subclinical MAC disease that becomes unmasked by HAART. The atypical mycobacteria observed in children are M avium-intracellulare complex, M scrofulaceum, and, rarely observed in children with AIDS, M kansasii.

Mycobacterium marinum is the causative agent of swimming pool granuloma. However, both rapidly growing and slow-growing species of NTM have been implicated in chronic granulomatous infections. Those infections mostly involve tendon sheaths, bursae, bones, and joints after direct inoculation through accidental trauma, surgical incisions, or puncture wounds.[3, 65] Tenosynovitis of the hand secondary to MAC and M marinum has been described. Osteomyelitis of the sternum caused by M abscessus has been found in clustered and sporadic outbreaks. M fortuitum and M chelonae strains, also known as the rapidly growing organisms, have occasionally been implicated in wound, soft tissue, pulmonary, and middle ear infections.[66, 7]

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Contributor Information and Disclosures
Author

Arry Dieudonne, MD Associate Professor of Pediatrics, Division of Pulmonology, Allergy, Immunology and Infectious Diseases, Rutgers New Jersey Medical School; Clinical Director, Francois-Xavier Bagnold Center for Children, University Hospital

Arry Dieudonne, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

James M Oleske, MD, MPH François-Xavier Bagnoud Professor of Pediatrics, Director, Division of Pulmonary, Allergy, Immunology and Infectious Diseases, Department of Pediatrics, Rutgers New Jersey Medical School; Professor, Department of Quantitative Methods, Rutgers New Jersey Medical School

James M Oleske, MD, MPH is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Allergy Asthma and Immunology, American Academy of Hospice and Palliative Medicine, American Association of Public Health Physicians, American College of Preventive Medicine, American Pain Society, Infectious Diseases Society of America, Infectious Diseases Society of New Jersey, Medical Society of New Jersey, Pediatric Infectious Diseases Society, Arab Board of Family Medicine, American Academy of Pain Management, National Association of Pediatric Nurse Practitioners, Association of Clinical Researchers and Educators, American Academy of HIV Medicine, American Thoracic Society, American Academy of Pediatrics, American Public Health Association, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc 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 Medical Association, American Society for Microbiology, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, Society for Ear, Nose and Throat Advances in Children, American Federation for Clinical Research, Surgical Infection Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

References
  1. Masson AM, Prissick FH. Cervical lymphadenitis in children caused by chromogenic Mycobacteria. Can Med Assoc J. 1956 Nov 15. 75(10):798-803. [Medline].

  2. Weed LA, Keith HM, Needham GM. Nontuberculous acid-fast cervical adenitis in children. Mayo Clin Proc. 1956 Apr 18. 31(8):259-63. [Medline].

  3. Wolinsky E. Nontuberculous mycobacteria and associated diseases. Am Rev Respir Dis. 1979 Jan. 119(1):107-59. [Medline].

  4. Silcox VA, Good RC, Floyd MM. Identification of clinically significant Mycobacterium fortuitum complex isolates. J Clin Microbiol. 1981 Dec. 14(6):686-91. [Medline].

  5. Wallace RJ, Brown BA, Silcox VA, et al. Clinical disease, drug susceptibility, and biochemical patterns of the unnamed third biovariant complex of Mycobacterium fortuitum. J Infect Dis. 1991 Mar. 163(3):598-603. [Medline].

  6. Wallace RJ, Silcox VA, Tsukamura M, et al. Clinical significance, biochemical features, and susceptibility patterns of sporadic isolates of the Mycobacterium chelonae-like organism. J Clin Microbiol. 1993 Dec. 31(12):3231-9. [Medline].

  7. Cross JT, Jacobs R. Other mycobacteria. Fegin, Cherry, eds. Textbook of Pediatric Infectious Diseases. Philadelphia, Pa: WB Saunders Co; 1998.

  8. Karne SS, Sangle SA, Kiyawat DS, Dharmashale SN, Kadam DB, Bhardwaj RS. Mycobacterium avium-intracellulare brain abscess in HIV-positive patient. Ann Indian Acad Neurol. 2012 Jan. 15(1):54-5. [Medline]. [Full Text].

  9. Shiratsuchi H, Johnson JL, Ellner JJ. Bidirectional effects of cytokines on the growth of Mycobacterium avium within human monocytes. J Immunol. 1991 May 1. 146(9):3165-70. [Medline].

  10. Denis M, Gregg EO. Recombinant tumour necrosis factor-alpha decreases whereas recombinant interleukin-6 increases growth of a virulent strain of Mycobacterium avium in human macrophages. Immunology. 1990 Sep. 71(1):139-41. [Medline].

  11. Bermudez LE, Wu M, Petrofsky M, Young LS. Interleukin-6 antagonizes tumor necrosis factor-mediated mycobacteriostatic and mycobactericidal activities in macrophages. Infect Immun. 1992 Oct. 60(10):4245-52. [Medline].

  12. Newman GW, Guarnaccia JR, Vance EA 3rd, et al. Interleukin-12 enhances antigen-specific proliferation of peripheral blood mononuclear cells from HIV-positive and negative donors in response to Mycobacterium avium. AIDS. 1994 Oct. 8(10):1413-9. [Medline].

  13. Frucht DM, Holland SM. Defective monocyte costimulation for IFN-gamma production in familialdisseminated Mycobacterium avium complex infection: abnormal IL-12regulation. J Immunol. 1996 Jul 1. 157(1):411-6. [Medline].

  14. Bermudez LE, Wu M, Young LS. Interleukin-12-stimulated natural killer cells can activate humanmacrophages to inhibit growth of Mycobacterium avium. Infect Immun. 1995 Oct. 63(10):4099-104. [Medline].

  15. Chin DP, Hopewell PC. Mycobacterium avium complex in the respiratory or gastrointestinal tract precedes MAC bacteremia. Front Mycobacteria. 1992. 15.

  16. Inderlied CB, Kemper CA, Bermudez LE. The Mycobacterium avium complex. Clin Microbiol Rev. 1993 Jul. 6(3):266-310. [Medline].

  17. Petrofsky M, Bermudez LE. CD4+ T cells but Not CD8+ or gammadelta+ lymphocytes are required for host protection against Mycobacterium avium infection and dissemination through the intestinal route. Infect Immun. 2005 May. 73(5):2621-7. [Medline].

  18. Levin M, Newport MJ, D'Souza S, et al. Familial disseminated atypical mycobacterial infection in childhood: a human mycobacterial susceptibility gene?. Lancet. 1995 Jan 14. 345(8942):79-83. [Medline].

  19. Pierre-Audigier C, Jouanguy E, Lamhamedi S, et al. Fatal disseminated Mycobacterium smegmatis infection in a child withinherited interferon gamma receptor deficiency. Clin Infect Dis. 1997 May. 24(5):982-4. [Medline].

  20. Altare F, Jouanguy E, Lamhamedi-Cherradi S, et al. A causative relationship between mutant IFNgR1 alleles and impaired cellular response to IFN-gamma in a compound heterozygous child. Am J Hum Genet. 1998 Mar. 62(3):723-6. [Medline].

  21. Casanova JL, Newport M, Fischer A. Inherited Interferon-gamma receptor deficiency. Ochs HD et al, eds. Primary Immunodeficiency Diseases. Oxford, England: Oxford University Press; 1999. 209-21.

  22. Dieudonne A, Oleske JM. Pediatric Human Immunodeficiency Virus Infection. Gorbach, Bartlett, Blacklow, eds. Infectious Diseases. 3rd ed. Lippincott Williams and Wilkins; 2004. 1056-99.

  23. Salyer KE, Votteler TP, Dorman GW. Surgical management of cervical adenitis due to atypical mycobacteria inchildren. JAMA. 1968 Jun 17. 204(12):1037-40. [Medline].

  24. MacGregor RR, Hafner R, Wu JW, et al. Clinical, microbiological, and immunological characteristics in HIV-infected subjects at risk for disseminated Mycobacterium avium complex disease: an AACTG study. AIDS Res Hum Retroviruses. 2005 Aug. 21(8):689-95. [Medline].

  25. Merone A, Saggiomo G, Severino G, et al. [Buruli ulcer. A case report]. Minerva Pediatr. 2001 Dec. 53(6):587-90. [Medline].

  26. Thomssen H. [Buruli ulcer. A mycobacterial skin disease]. Hautarzt. 2002 May. 53(5):334-7. [Medline].

  27. Ackumey MM, Gyapong M, Pappoe M, Weiss MG. Help-seeking for pre-ulcer and ulcer conditions of Mycobacterium ulcerans disease (Buruli ulcer) in Ghana. Am J Trop Med Hyg. 2011 Dec. 85(6):1106-13. [Medline]. [Full Text].

  28. Phanzu DM, Mahema RL, Suykerbuyk P, Imposo DH, Lehman LF, Nduwamahoro E, et al. Mycobacterium ulcerans infection (Buruli ulcer) on the face: a comparative analysis of 13 clinically suspected cases from the Democratic Republic of Congo. Am J Trop Med Hyg. 2011 Dec. 85(6):1100-5. [Medline]. [Full Text].

  29. Dankner WM, Lindsey JC, Levin MJ, et al. Correlates of opportunistic infections in children infected with the humanimmunodeficiency virus managed before highly active antiretroviraltherapy. Pediatr Infect Dis J. 2001 Jan. 20(1):40-8. [Medline].

  30. Puthanakit T, Oberdorfer P, Akarathum N, et al. Immune reconstitution syndrome after highly active antiretroviral therapy in human immunodeficiency virus-infected thai children. Pediatr Infect Dis J. 2006 Jan. 25(1):53-8. [Medline].

  31. Johann-Liang R, Cervia JS, Noel GJ. Characteristics of human immunodeficiency virus-infected children at the time of death: an experience in the 1990s. Pediatr Infect Dis J. 1997 Dec. 16(12):1145-50. [Medline].

  32. Keller C, Kirkpatrick S, Lee K, et al. Disseminated Mycobacterium avium complex presenting as hematochezia in an infant with rapidly progressive acquired immunodeficiency syndrome. Pediatr Infect Dis J. 1996 Aug. 15(8):713-5. [Medline].

  33. Centers for Disease Control and Prevention. 2001 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. MMWR. November 28, 2001. [Full Text].

  34. Rutstein RM, Cobb P, McGowan KL, et al. Mycobacterium avium intracellulare complex infection in HIV-infected children. AIDS. 1993 Apr. 7(4):507-12. [Medline].

  35. Le Bourgeois M, Sermet-Gaudelus I, Catherinot E, Gaillard JL. [Nontuberculous mycobacteria in cystic fibrosis]. Arch Pediatr. 2005 Aug. 12 Suppl 2:S117-21. [Medline].

  36. Mussaffi H, Rivlin J, Shalit I, et al. Nontuberculous mycobacteria in cystic fibrosis associated with allergic bronchopulmonary aspergillosis and steroid therapy. Eur Respir J. 2005 Feb. 25(2):324-8. [Medline].

  37. Horsburgh CR Jr, Caldwell MB, Simonds RJ. Epidemiology of disseminated nontuberculous mycobacterial disease in children with acquired immunodeficiency syndrome. Pediatr Infect Dis J. 1993 Mar. 12(3):219-22. [Medline].

  38. Hoyt L, Oleske J, Holland B, Connor E. Nontuberculous mycobacteria in children with acquired immunodeficiency syndrome. Pediatr Infect Dis J. 1992 May. 11(5):354-60. [Medline].

  39. Hartmann P, Plum G. Immunological defense mechanisms in tuberculosis and MAC-infection. Diagn Microbiol Infect Dis. 1999 Jun. 34(2):147-52. [Medline].

  40. O'Brien RJ. The epidemiology of nontuberculous mycobacterial disease. Clin Chest Med. 1989 Sep. 10(3):407-18. [Medline].

  41. Schonell ME, Crofton JW, Stuart AE, Wallace A. Disseminated infection with Mycobacterium avium: I. Clinical features,treatment and pathology. Tubercle. 1968 Mar. 49(1):12-30. [Medline].

  42. Dieudonne A, McSherry, GD, Holland B. Clinical outcome and survival time in a cohort of HIV-infected children with atypical mycobacterial infections. Abstract Book. Annual Meeting of Society of Pediatric Research. 1997. Abstract 697:

  43. Dieudonne A. Mycobacterium avium complex in HIV-infected infants and adolescents. Medical CME Program. Medical Word Communications. 1996. 8-10:

  44. Kayal JD, McCall CO. Sporotrichoid cutaneous Mycobacterium avium complex infection. J Am Acad Dermatol. 2002 Nov. 47(5 Suppl):S249-50. [Medline].

  45. Astagneau P, Desplaces N, Vincent V, et al. Mycobacterium xenopi spinal infections after discovertebral surgery: investigation and screening of a large outbreak. Lancet. 2001 Sep 1. 358(9283):747-51. [Medline].

  46. Brutus JP, Baeten Y, Chahidi N, et al. Atypical mycobacterial infections of the hand: report of eight cases and literature review. Chir Main. 2001 Aug. 20(4):280-6. [Medline].

  47. Arend SM, Janssen R, Gosen JJ, et al. Multifocal osteomyelitis caused by nontuberculous mycobacteria in patients with a genetic defect of the interferon-gamma receptor. Neth J Med. 2001 Sep. 59(3):140-51. [Medline].

  48. Nakamura T, Yamamura Y, Tsuruta T, et al. Mycobacterium kansasii arthritis of the foot in a patient with systemic lupus erythematosus. Intern Med. 2001 Oct. 40(10):1045-9. [Medline].

  49. Villella A, Picard C, Jouanguy E, et al. Recurrent Mycobacterium avium osteomyelitis associated with a novel dominant interferon gamma receptor mutation. Pediatrics. 2001 Apr. 107(4):E47. [Medline].

  50. Lidar M, Elkayam O, Goodwin D, et al. Protracted Mycobacterium kansasii carpal tunnel syndrome and tenosynovitis. Isr Med Assoc J. 2003 Jun. 5(6):453-4. [Medline].

  51. De Smet L. Mycobacterium marinum infections of the hand: a report of three cases. Acta Chir Belg. 2008 Nov-Dec. 108(6:779-82. [Medline].

  52. Tigges F, Bauer A, Hochauf K, Meurer M. Sporotrichoid atypical cutaneous infection caused by Mycobacterium marinum. Acta Dermatovenerol Alp Panonica Adriat. 2009 Mar. 18(1):31-4 [PubMed - in process]. [Medline].

  53. Azzam HC, Gahunia MK, Sae-Tia, Santoro J. Mycobacterium avium--associated typhlitis mimicking appendicitis in an immunocompetent host. Am J Med Sci. 2009 Mar. 337(3):218-20. [Medline].

  54. Thaunat O, Morelon E, Stern M, et al. Mycobacterium xenopi pulmonary infection in two renal transplant recipients under sirolimus therapy. Transpl Infect Dis. 2004 Dec. 6(4):179-82. [Medline].

  55. Stelzmueller I, Dunst KM, Wiesmayr S, et al. Mycobacterium chelonae skin infection in kidney-pancreas recipient. Emerg Infect Dis. 2005 Feb. 11(2):352-4. [Medline].

  56. Wright HL, Thomson RM, Reid AB, Carter R, Bartley PB, Newton P, et al. Rapidly growing mycobacteria associated with laparoscopic gastric banding, Australia, 2005-2011. Emerg Infect Dis. 2014 Oct. 20(10):1612-9. [Medline]. [Full Text].

  57. Hackethal V. Gastric Banding Linked to Mycobacterium Infections. Medscape Medical News. Available at http://www.medscape.com/viewarticle/831462. Accessed: January 7, 2015.

  58. Havlir D, Elnner JJ. Mycobacterium avium complex. Principle and Practice of Infectious Diseases. New York, NY: Churchill Livingstone; 2000. Vol 2: 2616-30.

  59. Chaisson RE, Moore RD, Richman DD, et al. Incidence and natural history of Mycobacterium avium-complex infections inpatients with advanced human immunodeficiency virus disease treated withzidovudine. The Zidovudine Epidemiology Study Group. Am Rev Respir Dis. 1992 Aug. 146(2):285-9. [Medline].

  60. Lim SD, Todd J, Lopez J, et al. Genotypic identification of pathogenic Mycobacterium species by using a nonradioactive oligonucleotide probe. J Clin Microbiol. 1991 Jun. 29(6):1276-8. [Medline].

  61. Phillips P, Zala C, Rouleau D. Mycobacterial lymphadenitis: Can highly active antiretroviral therapy (HAART) unmask subclinical infection? Abstract 351. In: Program and Abstracts of the 4th Conference on Retroviruses and Opportunistic Infections. January 22-26, 1997:

  62. Race EM, Adelson-Mitty J, Kriegel GR, et al. Focal mycobacterial lymphadenitis following initiation ofprotease-inhibitor therapy in patients with advanced HIV-1 disease. Lancet. 1998 Jan 24. 351(9098):252-5. [Medline].

  63. Kaplan MH. Mycobacterium avium-intracellulare (MAIS) reversal syndrome set off by highly active and anti-retroviral therapy (HAART). Improved immunity is not always good but it is better than no immunity. Abstract 726. In: Program and Abstracts of the 5th Conference. Alexandria, Va: Foundation for Retrovirology and Human Health. February 1-5, 1998:

  64. Shafran SD. Prevention and treatment of disseminated Mycobacterium avium complexinfection in human immunodeficiency virus-infected individuals. Int J Infect Dis. 1998 Jul-Sep. 3(1):39-47. [Medline].

  65. Wallace RJ, Musser JM, Hull SI, et al. Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac surgery. J Infect Dis. 1989 Apr. 159(4):708-16. [Medline].

  66. American Academy of Pediatrics. Diseases caused by nontuberculous Mycobacteria. Pickering LK, ed. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 2006.

  67. Stone AB, Schelonka RL, Drehner DM, et al. Disseminated Mycobacterium avium complex in non-human immunodeficiency virus-infected pediatric patients. Pediatr Infect Dis J. 1992 Nov. 11(11):960-4. [Medline].

  68. Dhooge I, Dhooge C, De Baets F, Van Cauwenberge P. Diagnostic and therapeutic management of atypical mycobacterial infections in children. Eur Arch Otorhinolaryngol. 1993. 250(7):387-91. [Medline].

  69. Da Silva Telles MA, Chimara E, Ferrazoli L, Riley LW. Mycobacterium kansasii: antibiotic susceptibility and PCR-restriction analysis of clinical isolates. J Med Microbiol. 2005 Oct. 54(Pt 10):975-9. [Medline].

  70. Hartman TE, Swensen SJ, Williams DE. Mycobacterium avium-intracellulare complex: evaluation with CT. Radiology. 1993 Apr. 187(1):23-6. [Medline].

  71. Tamura A, Muraki K, Shimada M, et al. [Usefulness of bronchofiberscopy for the diagnosis of pulmonary non-tuberculous mycobacteriosis--an analysis mainly on pulmonary M. avium complex disease]. Kekkaku. 2008 Dec. 83(12):785-91. [Medline].

  72. Nyberg DA, Federle MP, Jeffrey RB, et al. Abdominal CT findings of disseminated Mycobacterium avium-intracellularein AIDS. AJR Am J Roentgenol. 1985 Aug. 145(2):297-9. [Medline].

  73. Robbins SL, Cotran RS, Kumar V. Pathologic basis of disease. 1984, Saunders, third edition. 300-350.

  74. Torriani FJ, McCutchan JA, Bozzette SA, et al. Autopsy findings in AIDS patients with Mycobacterium avium complexbacteremia. J Infect Dis. 1994 Dec. 170(6):1601-5. [Medline].

  75. Rustom IK, Sandoe JA, Makura ZG. Paediatric neck abscesses: microbiology and management. J Laryngol Otol. 2007 Jun 11. 1-5. [Medline].

  76. Griffith DE, Brown BA, Girard WM, et al. Azithromycin-containing regimens for treatment of Mycobacterium avium complex lung disease. Clin Infect Dis. 2001 Jun 1. 32(11):1547-53. [Medline].

  77. Aberg JA, Yajko DM, Jacobson MA. Eradication of AIDS-related disseminated mycobacterium avium complex infection after 12 months of antimycobacterial therapy combined with highly active antiretroviral therapy. J Infect Dis. 1998 Nov. 178(5):1446-9. [Medline].

  78. Gordin FM, Sullam PM, Shafran SD, et al. A randomized, placebo-controlled study of rifabutin added to a regimen of clarithromycin and ethambutol for treatment of disseminated infection with Mycobacterium avium complex. Clin Infect Dis. 1999 May. 28(5):1080-5. [Medline].

  79. Ramirez J, Mason C, Ali J, Lopez FA. Mycobacterium avium complex pulmonary disease: management options in HIV-negative patients. J La State Med Soc. 2008 Sep-Oct. 160(5):248-54; quiz 254, 293. [Medline].

  80. Huang JH, Kao PN, Adi V, Ruoss SJ. Mycobacterium avium-intracellulare pulmonary infection in HIV-negative patients without preexisting lung disease: diagnostic and management limitations. Chest. 1999 Apr. 115(4):1033-40. [Medline]. [Full Text].

  81. Schütte D, Umboock A, Pluschke G. Phagocytosis of Mycobacterium ulcerans in the course of rifampicin and streptomycin chemotherapy in Buruli ulcer lesions. Br J Dermatol. Feb. 2009. 273-283. [Medline].

  82. Kuwabara K, Tsuchiya T. [Clinical features and treatment history of clarithromycin resistance in M. avium-intracellulare complex pulmonary disease patients]. Nihon Kokyuki Gakkai Zasshi. 2007 Aug. 45(8):587-92. [Medline].

  83. Centers for Disease Control and Prevention. 2002 USPHS/IDSA guidelines for prevention of opportunistic infections in persons with HIV. MMWR. 2002. [Full Text].

  84. El-Sadr WM, Burman WJ, Grant LB, et al. Discontinuation of prophylaxis for Mycobacterium avium complex disease in HIV-infected patients who have a response to antiretroviral therapy. Terry Beirn Community Programs for Clinical Research on AIDS. N Engl J Med. 2000 Apr 13. 342(15):1085-92. [Medline].

  85. Hawkins CC, Gold JW, Whimbey E, et al. Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1986 Aug. 105(2):184-8. [Medline].

  86. Wallace RJ Jr. Mycobacterium avium complex lung disease and women. Now an equal opportunity disease. Chest. 1994 Jan. 105(1):6-7. [Medline].

  87. Sohn CC, Schroff RW, Kliewer KE, et al. Disseminated Mycobacterium avium-intracellulare infection in homosexual men with acquired cell-mediated immunodeficiency: a histologic and immunologic study of two cases. Am J Clin Pathol. 1983 Feb. 79(2):247-52. [Medline].

  88. Horsburgh CR, Metchock B, Gordon SM, et al. Predictors of survival in patients with AIDS and disseminated Mycobacterium avium complex disease. J Infect Dis. 1994 Sep. 170(3):573-7. [Medline].

  89. Lewis LL, Butler KM, Husson RN, et al. Defining the population of human immunodeficiency virus-infected children at risk for Mycobacterium avium-intracellulare infection. J Pediatr. 1992 Nov. 121(5 Pt 1):677-83. [Medline].

  90. Jacobson MA, Hopewell PC, Yajko DM, et al. Natural history of disseminated Mycobacterium avium complex infection in AIDS. J Infect Dis. 1991 Nov. 164(5):994-8. [Medline].

  91. Chaudhuri S, Sarkar D, Mukerji R. Diagnosis and management of atypical mycobacterial infection after laparoscopic surgery. Indian J Surg. 2010 Dec. 72(6):438-42. [Medline]. [Full Text].

  92. Dhillon SS, Watanakunakorn C. Lady Windermere syndrome: middle lobe bronchiectasis and Mycobacterium avium complex infection due to voluntary cough suppression. Clin Infect Dis. 2000 Mar. 30(3):572-5. [Medline].

  93. Duraipandian J, Rengasamy G, Madasamy B, Kulanthaivelu A, Subramanian G. Subcutaneous aspergillosis with coexisting atypical mycobacterial infection. Indian J Pathol Microbiol. 2010 Apr-Jun. 53(2):359-60. [Medline].

  94. Hadad DJ, Lewi DS, Pignatari AC. Resolution of MAC bacteremia following highly active antiretroviral therapy. Abstract. In: Fifth Conference on Retroviruses and Opportunistic infections. 1998.

  95. Herbinger KH, Brieske D, Nitschke J, Siegmund V et al. Excision of pre-ulcerative forms of Buruli ulcer disease: a curative treatment?. Infection. Feb 2009. 37(1):20-5. [Medline].

  96. Jouanguy E, Altare F, Lamhamedi-Cherradi S, Casanova JL. Infections in IFNGR-1-deficient children. J Interferon Cytokine Res. 1997 Oct. 17(10):583-7. [Medline].

  97. Moore RD, Keruly JC, Chaisson RE. Decline in CMV and other opportunistic disease with combination antiretroviral therapy. Abstract 184. In: Program and Abstracts. of the 5th Conference on Retroviruses and Opportunistic Infections. Chicago, Ill: February 1-5,1998:

  98. Murphy R, El-Sadr W, Cheung T. Impact of protease inhibitor-containing regimen on the risk of developing opportunistic infections and mortality in the CPCRA 034/ACTG 277 study. Abstract 181. In: Program and Abstracts. of the 5th Conference on Retroviruses and Opportunistic Infections. Chicago, Ill: February 1-5,1998:

  99. Newport MJ, Huxley CM, Huston S, et al. A mutation in the interferon-gamma-receptor gene and susceptibility to mycobacterial infection. N Engl J Med. 1996 Dec 26. 335(26):1941-9. [Medline].

  100. Nightingale SD, Byrd LT, Southern PM, et al. Incidence of Mycobacterium avium-intracellulare complex bacteremia in human immunodeficiency virus-positive patients. J Infect Dis. 1992 Jun. 165(6):1082-5. [Medline].

 
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