Atypical Mycobacterial Infection Medication

  • Author: Arry Dieudonne, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 16, 2012
 

Medication Summary

The treatment regimen for pediatric patients infected with HIV with disseminated M avium complex (MAC) disease includes at least 2 antimicrobials, one of which should be either clarithromycin or azithromycin.[64, 74] Many experts prefer ethambutol as the second drug. Some clinicians have added a third or fourth agent from the following list: clofazimine, rifabutin, ciprofloxacin, or amikacin.[75, 64, 76, 33] The choice of therapy should be based on sensitivity reports before the combination regimen is started. Antiretroviral agents should be initiated within 1-2 weeks of MAC treatment for patients who have not previously received or are not currently receiving antiretroviral drugs.

The possible benefits of administering ciprofloxacin to a child infected with HIV who has developed disseminated MAC infection frequently outweighs cautions regarding ciprofloxacin use in children younger than 13 years.[75] Rifabutin induces CYP3A isoenzyme and, therefore, may reduce the plasma concentration of drugs metabolized by those enzymes (eg, itraconazole, clarithromycin, saquinavir).[76] Drugs that inhibit CYP3A (eg, delavirdine, indinavir, nelfinavir, ritonavir) may significantly increase rifabutin plasma concentration. In such cases, the rifabutin dose should be reduced. Therapy should continue for the lifetime of the patient if clinical and microbiologic improvement is observed.[75]

Despite multiple drug combination therapy, disseminated MAC disease treatment in children infected with HIV is still a challenge. Multiple drug-resistant strains are always present, and sensitivity rarely exceeds 2 or 3 drugs.[33] With prolonged survival time, children and adolescents develop resistance because of the duration of treatment. Clinical improvement, characterized by weight gain and absence of fever and diarrhea, may be present during the early treatment period; however, intolerance to medication, concurrent infections, and, sometimes, multiorgan failure, may impair the efficacy of a therapeutic regimen.

Therapy for disseminated MAC disease should be continued for life unless sustained immune recovery occurs with potent antiretroviral therapy.[75] Discontinuation of MAC therapy did not show resurgence in clinical symptoms and the presence of MAC in subsequent blood cultures. Ongoing clinical studies may suggest that MAC therapy may not need to be indefinitely continued.[56] In immunocompetent patients with lymphadenitis secondary to MAC, complete excision of major nodes is recommended. If excision is incomplete or disease recurs, clarithromycin or azithromycin plus ethambutol with rifampin should be used. That same regimen is recommended for pulmonary infections caused by MAC. However, management of MAC infection in HIV-negative patients without preexisting lung disease can be challenging.[77, 78]

Excision of tissue is recommended in disseminated cutaneous infection caused by M fortuitum complex. Initial therapy is amikacin plus cefoxitin intravenously, followed by erythromycin, clarithromycin, doxycycline, or ciprofloxacin orally. Doxycycline is contraindicated in children younger than 8 years. Fluoroquinolones are contraindicated in children younger than 18 years. For catheter-related infections, the usual treatment is catheter removal combined with appropriate antibiotics (amikacin plus cefoxitin) for 6-12 weeks.[3] Pulmonary infections and osteomyelitis caused by M kansasii are treated with rifampin plus ethambutol with isoniazid. Surgical debridement and prolonged antibiotic therapy may be necessary for patients with osteomyelitis.

Minor cutaneous infections caused by M marinum do not require any treatment. Rifampin, trimethoprim-sulfamethoxazole, clarithromycin, or doxycycline is used for moderate diseases. Surgical debridement may be required for extensive lesions. Patients with otitis media caused by M abscessus should receive clarithromycin plus an initial course of amikacin plus cefoxitin. Surgical debridement may be required. Pulmonary infection in patients with CF should be treated based on susceptibility testing. Some experts recommend a 1-month course of intravenous imipenem or cefoxitin plus amikacin followed by oral clarithromycin plus ethambutol for at least 12 months after negativation.[35] It may require surgical resection. Expert advice is recommended, and decisions should be made in consultation with a pediatric infectious disease specialist.

Dual therapy with rifampicin and streptomycin as well as surgical debridement is the standard treatment recommended for patients with Buruli ulcer.[79] The combination of rifampicin and streptomycin results in a rapid onset of local cellular responses associated with phagocytosis of the extracellular M ulcerans. This may be related to declining levels of the macrolide toxin mycolactone in the tissue, thus leading to an enhanced chemotherapy-induced clearance of the infection.[79]

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Antibiotic

Class Summary

Indicated for treatment and prevention of disseminated MAC disease. The choice of therapy should be based on sensitivity reports before antimicrobial initiation. Regimens for treatment include 2 or more antimicrobials.

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Azithromycin (Zithromax)

 

Macrolide that inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used in combination with at least one other drug for treatment of disseminated MAC disease and as a primary prophylactic agent in patients who are severely immunocompromised based on their CD4+ lymphocyte count.

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Clarithromycin (Biaxin)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Erythromycin (EES, E-Mycin, Eryc, Ery-Tab)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest. In children, infection severity determines proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.

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Ciprofloxacin (Cipro)

 

Fluoroquinolone with activity against pseudomonas, streptococci, MRSA, Staphylococcus epidermidis, most gram-negative organisms, and atypical mycobacteria, but no activity against anaerobes. Inhibits bacterial DNA synthesis and consequently growth.

Safety and effectiveness in pediatric patients and adolescents have not been established. Risks versus benefits should be outweighed in cases of disseminated MAC disease.

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Cefoxitin (Mefoxin)

 

Second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections. Used in combination with other antibiotics for infections due to rapid-growing atypical mycobacteria. Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin.

Combine with amikacin when used to treat M fortuitum complex.

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Doxycycline (Bio-Tab, Doryx, Doxy, Vibramycin, Vibra-Tabs)

 

Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

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Sulfamethoxazole-Trimethoprim (Bactrim, Septra)

 

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.

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Rifampin (Rifadin)

 

Inhibits RNA synthesis in bacteria by binding to beta subunit of DNA-dependent RNA polymerase, which, in turn, blocks RNA transcription.

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Rifabutin (Mycobutin)

 

Ansamycin antibiotic derived from rifamycin S. Inhibits DNA-dependent RNA polymerase, preventing chain initiation in susceptible strains of Escherichia coli and Bacillus subtilis but not in mammalian cells. If GI upset occurs, administer dose bid with food. Liquid formulation suitable for children is not currently available in the United States.

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Ethambutol (Myambutol)

 

Diffuses into actively growing mycobacterial cells, such as tubercle bacilli. Impairs cell metabolism by inhibiting synthesis of one or more metabolites, which in turn causes cell death. No cross-resistance demonstrated. Mycobacterial resistance is frequent with previous therapy. Use in these patients in combination with second-line drugs that have not been previously administered.

Administer q24h until permanent bacteriologic conversion and maximal clinical improvement is observed. Absorption is not significantly altered by food.

Used in combination with azithromycin or clarithromycin for MAC treatment or secondary prophylaxis.

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Isoniazid (Nydrazid)

 

Best combination of effectiveness, low cost, and minor side effects. First-line drug unless known resistance or another contraindication exists. Therapeutic regimens of < 6 mo demonstrate unacceptably high relapse rate. Coadministration of pyridoxine is recommended if peripheral neuropathies secondary to isoniazid therapy develop. Prophylactic doses of 6-50 mg of pyridoxine daily are recommended.

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Clofazimine (Lamprene)

 

Inhibits mycobacterial growth, binds preferentially to mycobacterial DNA. Has antimicrobial properties, but mechanism of action is unknown.

Always use with other antitubercular agents. Because of severe toxicities, clofazimine should be considered only if no other effective antimycobacterial agent can be used based on resistance testing.

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Contributor Information and Disclosures
Author

Arry Dieudonne, MD  Associate Professor of Pediatrics, Division of Pulmonology, Allergy, Immunology and Infectious Diseases, University of Medicine and Dentistry of New Jersey-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, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

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

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

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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 Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, 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 Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

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  American Legion 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, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

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, and Southern Medical Association

Disclosure: Nothing to disclose.

References

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

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

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

  4. Silcox VA, Good RC, Floyd MM. Identification of clinically significant Mycobacterium fortuitum complex isolates. J Clin Microbiol. Dec 1981;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. Mar 1991;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. Dec 1993;31(12):3231-9. [Medline].

  7. Cross JT, Jacobs R. Other mycobacteria. In: 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. Jan 2012;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. May 1 1991;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. Sep 1990;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. Oct 1992;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. Oct 1994;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. Jul 1 1996;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. Oct 1995;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. Jul 1993;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. May 2005;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. Jan 14 1995;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. May 1997;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. Mar 1998;62(3):723-6. [Medline].

  21. Casanova JL, Newport M, Fischer A. Inherited Interferon-gamma receptor deficiency. In: 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. In: 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. Jun 17 1968;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. Aug 2005;21(8):689-95. [Medline].

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

  26. Thomssen H. [Buruli ulcer. A mycobacterial skin disease]. Hautarzt. May 2002;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. Dec 2011;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. Dec 2011;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. Jan 2001;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. Jan 2006;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. Dec 1997;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. Aug 1996;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. Apr 1993;7(4):507-12. [Medline].

  35. Le Bourgeois M, Sermet-Gaudelus I, Catherinot E, Gaillard JL. [Nontuberculous mycobacteria in cystic fibrosis]. Arch Pediatr. Aug 2005;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. Feb 2005;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. Mar 1993;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. May 1992;11(5):354-60. [Medline].

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

  40. O'Brien RJ. The epidemiology of nontuberculous mycobacterial disease. Clin Chest Med. Sep 1989;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. Mar 1968;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. Nov 2002;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. Sep 1 2001;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. Aug 2001;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. Sep 2001;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. Oct 2001;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. Apr 2001;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. Jun 2003;5(6):453-4. [Medline].

  51. De Smet L. Mycobacterium marinum infections of the hand: a report of three cases. Acta Chir Belg. Nov-Dec 2008;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. Mar 2009;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. Mar 2009;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. Dec 2004;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. Feb 2005;11(2):352-4. [Medline].

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

  57. 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. Aug 1992;146(2):285-9. [Medline].

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

  59. 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.

  60. 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. Jan 24 1998;351(9098):252-5. [Medline].

  61. 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.

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

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

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

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

  66. 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].

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

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

  69. 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. Dec. 2008;83(12):785-91. [Medline].

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

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

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

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

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

  75. 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. Nov 1998;178(5):1446-9. [Medline].

  76. 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. May 1999;28(5):1080-5. [Medline].

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

  78. 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. Apr 1999;115(4):1033-40. [Medline]. [Full Text].

  79. 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].

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

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

  82. 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. Apr 13 2000;342(15):1085-92. [Medline].

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

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

  85. 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. Feb 1983;79(2):247-52. [Medline].

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

  87. 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. Nov 1992;121(5 Pt 1):677-83. [Medline].

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

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

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

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

  92. 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.

  93. 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].

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

  95. 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.

  96. 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.

  97. 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. Dec 26 1996;335(26):1941-9. [Medline].

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

 
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