Bacterial agents isolated from cerebrospinal fluid of patients with Acquired Immunodeficiency Syndrome (AIDS) and neurological complications

Landgraf, Ilka Maria; Palaci, Moisés; Vieira, Maria de Fátima Paiva; Ueki, Sueli Yoko Mizuka; Martins, Maria Conceição; Sato, Daisy Nakamura; Ferrazoli, Lucilaine; Telles, Maria Alice Silva; Gorla, Maria Cecília Outeiro; Vaz, Tania Mara Ibelli; Lorenço, Rosemarie; Marques, Lilian Regina Macelloni

doi:10.1590/S0036-46651994000600003

Abstracts

Cerebrospinal fluid (CSF) samples from 2083 patients with acquired immunodeficiency syndrome (AIDS) and neurological complications were bacteriologically examined during a period of 7 years (1984-1990). The percentage of patients who had at least one bacterial agent cultured from the CSF was 6.2%. Mycobacterium tuberculosis was the most frequently isolated agent (4.3%), followed by Mycobacterium avium complex or MAC (0.7%), Pseudomonas spp (0.5%), Enterobacter spp (0.4%), and Staphylococcus aureus (0.3%). Among 130 culture positive patients, 89 (68.5%) had M. tuberculosis and 15 (11.6%) had MAC. The frequency of bacterial isolations increased from 1988 (5.2%) to 1990 (7.2%), partly due to the increase in MAC isolations. Bacterial agents were more frequently isolated from patients in the age group 21-30 years and from women (p<0.05).

Acquired Immunodeficiency Syndrome; Cerebrospinal fluid; Bacterial agents

Amostras de líquido cefalorraquidiano (LCR) de 2083 pacientes com Síndrome de Imunodeficiência Adquirida (SIDA) e complicações neurológicas foram examinados durante um período de 7 anos (1984-1990). A porcentagem de pacientes que tiveram pelo menos um agente bacteriano cultivado do LCR foi de 6,2%. Mycobacterium tuberculosis foi o mais frequentemente isolado (4,3%), seguido do complexo Mycobacterium avium ou MAC (0,7%), de Pseudomonas spp (0,5%), Enterobacter spp (0,4%), e Staphylococcus aureus (0,3%). Entre 130 pacientes com cultura positiva, de 89 (68,5%) foi isolado M. tuberculosis e de 15 (11,6%) MAC. A frequência de isolamentos bacterianos aumentou de 1988 (5,2%) a 1990 (7,2%), particularmente devido ao maior isolamento de MAC. Os agentes bacterianos foram mais frequentemente isolados de pacientes na faixa etária de 21-30 anos e de mulheres (p<0.05).

MICROBIOLOGY

Bacterial agents isolated from cerebrospinal fluid of patients with Acquired Immunodeficiency Syndrome (AIDS) and neurological complications

Agentes bacterianos isolados de líquido cefalorraquidiano de pacientes com Síndrome de Imunodeficiência Adquirida (SIDA) e complicações neurológicas

Ilka Maria Landgraf^I; Moisés Palaci^I; Maria de Fátima Paiva Vieira^I; Sueli Yoko Mizuka Ueki^I; Maria Conceição Martins^I; Daisy Nakamura Sato^I; Lucilaine Ferrazoli^I; Maria Alice Silva Telles^I; Maria Cecília Outeiro Gorla^I; Tania Mara Ibelli Vaz^I; Rosemarie Lorenço^II; Lilian Regina Macelloni Marques^I

^ISeção de Bacteriologia, Instituto Adolfo Lutz, Av. Dr. Arnaldo 355, 01246-902 São Paulo, SP, Brasil

^IIInstituto de Infectologia Emílio Ribas, Av. Dr. Arnaldo, 165, 01245-901 São Paulo, SP, Brasil

^{Correspondence to} Correspondence to: Ilka Maria Landgraf Seção de Bacteriologia, Instituto Adolfo Lutz Av. Dr. Arnaldo 355 01246-902 São Paulo, SP, Brasil Fax: 055-011-851-3505

SUMMARY

Cerebrospinal fluid (CSF) samples from 2083 patients with acquired immunodeficiency syndrome (AIDS) and neurological complications were bacteriologically examined during a period of 7 years (1984-1990). The percentage of patients who had at least one bacterial agent cultured from the CSF was 6.2%. Mycobacterium tuberculosis was the most frequently isolated agent (4.3%), followed by Mycobacterium avium complex or MAC (0.7%), Pseudomonas spp (0.5%), Enterobacter spp (0.4%), and Staphylococcus aureus (0.3%). Among 130 culture positive patients, 89 (68.5%) had M. tuberculosis and 15 (11.6%) had MAC. The frequency of bacterial isolations increased from 1988 (5.2%) to 1990 (7.2%), partly due to the increase in MAC isolations. Bacterial agents were more frequently isolated from patients in the age group 21-30 years and from women (p<0.05).

Keywords: Acquired Immunodeficiency Syndrome; Cerebrospinal fluid; Bacterial agents.

RESUMO

Amostras de líquido cefalorraquidiano (LCR) de 2083 pacientes com Síndrome de Imunodeficiência Adquirida (SIDA) e complicações neurológicas foram examinados durante um período de 7 anos (1984-1990). A porcentagem de pacientes que tiveram pelo menos um agente bacteriano cultivado do LCR foi de 6,2%. Mycobacterium tuberculosis foi o mais frequentemente isolado (4,3%), seguido do complexo Mycobacterium avium ou MAC (0,7%), de Pseudomonas spp (0,5%), Enterobacter spp (0,4%), e Staphylococcus aureus (0,3%). Entre 130 pacientes com cultura positiva, de 89 (68,5%) foi isolado M. tuberculosis e de 15 (11,6%) MAC. A frequência de isolamentos bacterianos aumentou de 1988 (5,2%) a 1990 (7,2%), particularmente devido ao maior isolamento de MAC. Os agentes bacterianos foram mais frequentemente isolados de pacientes na faixa etária de 21-30 anos e de mulheres (p<0.05).

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Recebido para publicação em 18/04/1994.

Aceito para publicação em 17/06/1994.

1. ALBRITTON, W.L.; WIGGINS, G.L.; De WITT, W.E. & FEELEY, J.C. - Listeria monocytogenes. In: LENNETTE, E.H.; BALLOWS, A.; HAUSLER Jr., W.J. & TRUANT, J.P., ed. Manual of clinical microbiology. Washington, American Society for Microbiology, 1980. p. 139-142.
2. ATWOOD, W.J.; BERGER, J.R.; KADERMAN, R.; TORNATORE, C.S. & MAJOR, E.O. - Human immunodeficiency virus type 1 infection of the brain. Clin. Microbiol. Rev., 6: 339-366, 1993.
3. BARNES, P.F.; BLOCH, A.B.; DAVIDSON, P.T. & SNIDER Jr., D.E. - Tuberculosis in patients with human immunodeficiency virus infection. New Engl. J. Med., 324: 1644-1650, 1991.
4. BENSON, C.A. & ELLNER, J.J. - Mycobacterium avium complex infection and AIDS: advances in theory and practice. Clin. infect. Dis., 17: 7-20, 1993.
5. BERENGUER, J.; MORENO, S.; LAGUNA, F. et al. - Tuberculous meningitis in patients infected with the human immunodeficiency virus. New Engl. J. Med., 326: 668-672, 1992.
6. BISHBURG, E.; SUNDERAM, G.; REICHMAN, L.B. & KAPILA, R. - Central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex. Ann. intern. Med., 105: 210-213, 1986.
7. CENTERS FOR DISEASE CONTROL - Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. M. M. W. R., 36 (suppl.): 1S-15S, 1987.
8. DAVID, H.; LEVY-FREBAULT, V. & PAPA, F. - Méthodes de laboratoire pour mycobactériologie clinique. Paris, Institut Pasteur, 1986.
9. EDWARDS, P.R. & EWING, W.H. - Identification of Enterobacteriaceae. Minneapolis, Burgess Publishing, 1972.
10. FACKLAM, R.R. - Streptococci and Aerococci. In: LENNETTE, E.H.; BALOWS, A.; HAUSLER Jr., W.J. & TRUANT, J.P., ed. Manual of clinical microbiology. Washington, American Society for Microbiology, 1980. p. 88-110.
11. GRADON, J.D.; TIMPONE, J.G. & SCHNITTMAN, S.M. - Emergence of unusual opportunistic pathogens in AIDS: a review. Clin. infect. Dis., 15: 134-157, 1992.
12. GRAY, F.; GHERARDI, R. & SCARAVILLI, F. - The neuropathology of the acquired immune deficiency syndrome (AIDS). A review. Brain, 111: 245-266, 1988.
13. HORSBURGH Jr., C.R. - Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. New Engl. J. Med., 324: 1332-1338, 1991.
14. HUGH, R. & GILARDI, G.L. - Pseudomonas. In: LENNETTE, E.H.; BALOWS, S.; HAUSLER Jr., W.J. & TRUANT, J.P., ed. Manual of clinical microbiology. Washington, American Society for Microbiology, 1980. p. 288-317.
15. INDERLIED, C.B.; KEMPER, C.A. & BERMUDEZ, L.E.M. - The Mycobacterium avium complex. Clin. Microbiol. Rev., 6: 266-310, 1993.
16. JACOB, C.N.; HENEIN, S.S.; HEURICH, A.E. & KAMHOLZ, S. - Nontuberculous mycobacterial infection of the central nervous system in patients with AIDS. Sth. med. J. (Bgham., Ala.), 86: 638-640, 1993.
17. KLATT, E.C.; JENSEN, D.F. & MEYER, P.R. - Pathology of Mycobacterium avium-intracellulare infection in acquired immunodeficiency syndrome. Hum. Path., 18: 709-714, 1987.
18. KLOOS, W.E. & SCHLEIFER, K.H. - Simplified scheme for routine identification of human Staphylococcus species. J. clin. Microbiol., 1: 82-88, 1975.
19. LANDGRAF, I.M. & VIEIRA, M.F.P. - Biotypes and serotypes of Haemophilus influenzae from patients with meningitis in the City of Săo Paulo, Brazil. J. clin. Microbiol., 31: 743-745, 1993.
20. LEVY, R.M.; BREDESEN, D.E. & ROSENBLUM, M.L. - Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J. Neurosurg., 62: 475-495, 1985.
21. MARTIN, T.; CHEKE, D. & NATYSHAK, I. - Broth culture: the modern "guinea-pig" for isolation of mycobacteria. Tubercle (Edinb.), 70: 53-56, 1989.
22. MORLA, N.; GUIBOURDENCHE, M. & RIOU, J.Y. - Neisseria spp and AIDS. J. clin. Microbiol., 30: 2290-2294, 1992.
23. OGAWA, S.K.; SMITH, M.A.; BRENNESSEL, D.J. & LOWY, F.D. - Tuberculous meningitis in an urban medical center. Medicine, 66: 317-326, 1987.
24. RAVIGLIONE, M.C.; TIERNO, P.M.; OTTUSO, P. & DAVIDSON, M. - Group G streptococcal meningitis and sepsis in a patient with AIDS. A method to biotype group G Streptococcus. Diagn. Microbiol. infect. Dis., 13: 261-264, 1990.
25. SHAFER, R.W.; KIM, D.S.; WEISS, J.P. & QUALE, J.M. - Extrapulmonary tuberculosis in patients with human immunodeficiency virus infection. Medicine, 70: 384-397, 1991.
26. SILVA, E.A.M.; MELLES, C.E.A.; SATO, D.N. et al. - Bacteriological and epidemiological aspects of the diagnosis of Mycobacterium tuberculosis as the etiological agent of meningitis. Rev. Hosp. S. Paulo Esc. paul. Med., 1: 74-76, 1989.
27. SLUTSKER, L.; CASTRO, K.G.; WARD, J.W. & DOOLEY Jr., S.W. - Epidemiology of extrapulmonary tuberculosis among persons with AIDS in the United States. Clin. infect. Dis., 16: 513-518, 1993.
28. SMALL, P.M.; SCHECTER, G.F.; GOODMAN, P.C. et al. - Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. New Engl. J. Med., 324: 289-294, 1991.
29. VESTAL, A.L. - Procedures for the isolation and identification of mycobacteria. Washington, U.S. Department of Health, Education, and Welfare, 1976. (HEW publication CDC n° 76-8230).
30. WALLACE, J.M. & HANNAH, J.B. - Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome. A clinicopathologic study. Chest, 93: 926-932, 1988.
31. WITT, D.J.; CRAVEN, D.E. & McCABE, W.R. - Bacterial infections in adult patients with the acquired immune deficiency syndrome (AIDS) and AIDS-related complex. Amer. J. Med., 82: 900-906, 1987.

Correspondence to:

Ilka Maria Landgraf

Seção de Bacteriologia, Instituto Adolfo Lutz

Av. Dr. Arnaldo 355

01246-902 São Paulo, SP, Brasil

Fax: 055-011-851-3505

Publication Dates

Publication in this collection
05 July 2006
Date of issue
Dec 1994

History

Accepted
17 June 1994
Received
18 Apr 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ALBRITTON, W.L.; WIGGINS, G.L.; De WITT, W.E. & FEELEY, J.C. - Listeria monocytogenes. In: LENNETTE, E.H.; BALLOWS, A.; HAUSLER Jr., W.J. & TRUANT, J.P., ed. Manual of clinical microbiology. Washington, American Society for Microbiology, 1980. p. 139-142.

[2] 2. ATWOOD, W.J.; BERGER, J.R.; KADERMAN, R.; TORNATORE, C.S. & MAJOR, E.O. - Human immunodeficiency virus type 1 infection of the brain. Clin. Microbiol. Rev., 6: 339-366, 1993.

[3] 3. BARNES, P.F.; BLOCH, A.B.; DAVIDSON, P.T. & SNIDER Jr., D.E. - Tuberculosis in patients with human immunodeficiency virus infection. New Engl. J. Med., 324: 1644-1650, 1991.

[4] 4. BENSON, C.A. & ELLNER, J.J. - Mycobacterium avium complex infection and AIDS: advances in theory and practice. Clin. infect. Dis., 17: 7-20, 1993.

[5] 5. BERENGUER, J.; MORENO, S.; LAGUNA, F. et al. - Tuberculous meningitis in patients infected with the human immunodeficiency virus. New Engl. J. Med., 326: 668-672, 1992.

[6] 6. BISHBURG, E.; SUNDERAM, G.; REICHMAN, L.B. & KAPILA, R. - Central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex. Ann. intern. Med., 105: 210-213, 1986.

[7] 7. CENTERS FOR DISEASE CONTROL - Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. M. M. W. R., 36 (suppl.): 1S-15S, 1987.

[8] 8. DAVID, H.; LEVY-FREBAULT, V. & PAPA, F. - Méthodes de laboratoire pour mycobactériologie clinique. Paris, Institut Pasteur, 1986.

[9] 9. EDWARDS, P.R. & EWING, W.H. - Identification of Enterobacteriaceae. Minneapolis, Burgess Publishing, 1972.

[10] 10. FACKLAM, R.R. - Streptococci and Aerococci. In: LENNETTE, E.H.; BALOWS, A.; HAUSLER Jr., W.J. & TRUANT, J.P., ed. Manual of clinical microbiology. Washington, American Society for Microbiology, 1980. p. 88-110.

[11] 11. GRADON, J.D.; TIMPONE, J.G. & SCHNITTMAN, S.M. - Emergence of unusual opportunistic pathogens in AIDS: a review. Clin. infect. Dis., 15: 134-157, 1992.

[12] 12. GRAY, F.; GHERARDI, R. & SCARAVILLI, F. - The neuropathology of the acquired immune deficiency syndrome (AIDS). A review. Brain, 111: 245-266, 1988.

[13] 13. HORSBURGH Jr., C.R. - Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. New Engl. J. Med., 324: 1332-1338, 1991.

[14] 14. HUGH, R. & GILARDI, G.L. - Pseudomonas. In: LENNETTE, E.H.; BALOWS, S.; HAUSLER Jr., W.J. & TRUANT, J.P., ed. Manual of clinical microbiology. Washington, American Society for Microbiology, 1980. p. 288-317.

[15] 15. INDERLIED, C.B.; KEMPER, C.A. & BERMUDEZ, L.E.M. - The Mycobacterium avium complex. Clin. Microbiol. Rev., 6: 266-310, 1993.

[16] 16. JACOB, C.N.; HENEIN, S.S.; HEURICH, A.E. & KAMHOLZ, S. - Nontuberculous mycobacterial infection of the central nervous system in patients with AIDS. Sth. med. J. (Bgham., Ala.), 86: 638-640, 1993.

[17] 17. KLATT, E.C.; JENSEN, D.F. & MEYER, P.R. - Pathology of Mycobacterium avium-intracellulare infection in acquired immunodeficiency syndrome. Hum. Path., 18: 709-714, 1987.

[18] 18. KLOOS, W.E. & SCHLEIFER, K.H. - Simplified scheme for routine identification of human Staphylococcus species. J. clin. Microbiol., 1: 82-88, 1975.

[19] 19. LANDGRAF, I.M. & VIEIRA, M.F.P. - Biotypes and serotypes of Haemophilus influenzae from patients with meningitis in the City of Săo Paulo, Brazil. J. clin. Microbiol., 31: 743-745, 1993.

[20] 20. LEVY, R.M.; BREDESEN, D.E. & ROSENBLUM, M.L. - Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J. Neurosurg., 62: 475-495, 1985.

[21] 21. MARTIN, T.; CHEKE, D. & NATYSHAK, I. - Broth culture: the modern "guinea-pig" for isolation of mycobacteria. Tubercle (Edinb.), 70: 53-56, 1989.

[22] 22. MORLA, N.; GUIBOURDENCHE, M. & RIOU, J.Y. - Neisseria spp and AIDS. J. clin. Microbiol., 30: 2290-2294, 1992.

[23] 23. OGAWA, S.K.; SMITH, M.A.; BRENNESSEL, D.J. & LOWY, F.D. - Tuberculous meningitis in an urban medical center. Medicine, 66: 317-326, 1987.

[24] 24. RAVIGLIONE, M.C.; TIERNO, P.M.; OTTUSO, P. & DAVIDSON, M. - Group G streptococcal meningitis and sepsis in a patient with AIDS. A method to biotype group G Streptococcus. Diagn. Microbiol. infect. Dis., 13: 261-264, 1990.

[25] 25. SHAFER, R.W.; KIM, D.S.; WEISS, J.P. & QUALE, J.M. - Extrapulmonary tuberculosis in patients with human immunodeficiency virus infection. Medicine, 70: 384-397, 1991.

[26] 26. SILVA, E.A.M.; MELLES, C.E.A.; SATO, D.N. et al. - Bacteriological and epidemiological aspects of the diagnosis of Mycobacterium tuberculosis as the etiological agent of meningitis. Rev. Hosp. S. Paulo Esc. paul. Med., 1: 74-76, 1989.

[27] 27. SLUTSKER, L.; CASTRO, K.G.; WARD, J.W. & DOOLEY Jr., S.W. - Epidemiology of extrapulmonary tuberculosis among persons with AIDS in the United States. Clin. infect. Dis., 16: 513-518, 1993.

[28] 28. SMALL, P.M.; SCHECTER, G.F.; GOODMAN, P.C. et al. - Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. New Engl. J. Med., 324: 289-294, 1991.

[29] 29. VESTAL, A.L. - Procedures for the isolation and identification of mycobacteria. Washington, U.S. Department of Health, Education, and Welfare, 1976. (HEW publication CDC n° 76-8230).

[30] 30. WALLACE, J.M. & HANNAH, J.B. - Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome. A clinicopathologic study. Chest, 93: 926-932, 1988.

[31] 31. WITT, D.J.; CRAVEN, D.E. & McCABE, W.R. - Bacterial infections in adult patients with the acquired immune deficiency syndrome (AIDS) and AIDS-related complex. Amer. J. Med., 82: 900-906, 1987.