Disseminated Mycobacterium avium Infection with Different Clinical Presentation in Two Human Immunodeficiency Virus-positive Patients

• Published in: International journal of mycobacteriology Vol. 13; no. 1; pp. 112 - 114
• Main Authors: Yancheva, Nina, Strashimirov, Dimitar, Ivanov, Daniel, Grozdeva, Rusina, Bachiyska, Elizabeta, Milanov, Vladimir
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.01.2024; Wolters Kluwer Medknow Publications
• Subjects: Adult; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - microbiology; Development and progression; disseminated infection; Emtricitabine; Fatal Outcome; Health aspects; HIV (Viruses); HIV Infections - complications; HIV patients; human immunodeficiency virus; Humans; immune deficiency; Infection; Male; mycobacterium avium; Mycobacterium avium Complex - isolation & purification; Mycobacterium avium-intracellulare Infection - complications; Mycobacterium avium-intracellulare Infection - drug therapy; Mycobacterium avium-intracellulare Infection - microbiology; Sputum - microbiology
• ISSN: 2212-5531; 2212-554X
• DOI: 10.4103/ijmy.ijmy_23_24

Microorganisms belonging to the Mycobacterium avium complex (MAC) are ubiquitous in the environment, but only a minority of infected persons develop disease. An underlying lung disease or immune deficiency is a prerequisite for clinical manifestation. However, disseminated MAC disease primarily manifests in people living with human immunodeficiency virus (HIV) in the severe immunodeficiency stage with a whole host of clinical symptoms. We present two cases of disseminated M. avium infection in people living with HIV in the stage of severe immunodeficiency. Both patients exhibited distinct disease progression, with the absence of pulmonary symptoms being a common characteristic. The first patient predominantly experienced high fever, accompanied by diarrhea and severe anemia. The normothermia in the second patient was incongruent with the presence of marked cachexia, severe abdominal pain, and magnetic resonance imaging evidence of abdominal lymph node involvement. The causative agent was isolated from both sputum and stools. The patients underwent treatment that comprised aminoglycoside, macrolide, ethambutol, and rifampicin. Although both patients achieved optimal viral suppression of HIV, the immunologic response to antiretroviral therapy was suboptimal. The first patient died in the setting of severe immunodeficiency due to the development of decompensated liver cirrhosis, while the second patient demonstrated a slight reverse course of the disease.