History

Infection with M xenopi may result in pulmonary infection, usually in older adults with COPD, in patients who are immunocompromised with disseminated disease, or in patients with extrapulmonary disease involving the lymphatic system, skin, bones, or joints.^{[3, 4]}Onset of symptoms is insidious, and the infection may progress slowly or increase and decrease over the course of months or years.

Presenting symptoms

See the list below:

Chronic productive cough (90%)
Dyspnea (80%)
Constitutional symptoms such as weakness, malaise, and weight loss (90%)
Hemoptysis (20%)
Night sweats (20%)
Fever (10%)

Presenting symptoms of immunocompromised patients with disseminated disease

See the list below:

Prolonged febrile illness (95%)
Wasting syndrome (95%)

Possible presenting symptoms of patients with HIV infection

See the list below:

Advanced disease
Low CD4+ cell counts (< 50/µL)
Prior AIDS-defining illness

Physical

Physical findings relate to underlying long-term illness and are not specific for M xenopi infection. More than 95% of patients have abnormal lung findings.

Causes

Predisposing factors include the following:

Preexisting lung disease (eg, COPD, bronchiectasis)
Pulmonary or extrapulmonary malignancy
Alcoholism
Diabetes mellitus
Immunocompromised state (eg, HIV infection, AIDS)
Exposure via inhalation of aerosolized water infected with M xenopi or contact with infected water droplets

Sirolimus therapy inhibits interleukin 12–induced proliferation of activated T lymphocytes and may be a risk factor.

Varghese et al have described a patient data set in which the risk factors for M xenopi infection were pre-existing lung diseases such as emphysema.^[5]

Complications

See the list below:

Chronic wasting syndrome
Respiratory failure
Chronic respiratory illness
Disseminated disease
Death

Differential Diagnoses

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Author

Mansoor Arif, MD Hospitalist, Department of Medicine, Mount Auburn Hospital; Instructor, Department of Medicine, Harvard Medical School

Mansoor Arif, MD is a member of the following medical societies: American College of Physicians, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Syed Faisal Mahmood, MBBS Associate Professor of Infectious Diseases, Program Director, Infectious Diseases Fellowship Program, Department of Medicine, Aga Khan University Hospital, Pakistan

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron E Glatt, MD, MACP, FIDSA, FSHEA Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, Mount Sinai South Nassau; Professor of Medicine, Icahn School of Medicine at Mount Sinai

Aaron E Glatt, MD, MACP, FIDSA, FSHEA is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, 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, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Acknowledgements

Martin Backer, MD Fellow in Combined Adult and Pediatric Infectious Diseases, State University of New York Health Sciences Center