Mycobacterium avium complex (MAC): an unusual potential pathogen in cerebrospinal fluid of AIDS patients

Hadad, David Jamil; Petry, Tereza Cristina; Maresca, Anaenza Freie; Ferrazoli, Lucilaine; Martins, Maria Conceição; Palhares, Maria Cecilia de Almeida; Pinto, Walkyria Pereira; Castelo Filho, Adauto; Palaci, Moises

doi:10.1590/S0036-46651995000200001

Abstracts

Mycobacterium avium complex (MAC) is frequently isolated from patients with late complications of Acquired Immunodeficiency Syndrome (AIDS), especially in North America and Europe. However, its isolation from the central nervous system (CNS) has been seldom reported in these countries. MAC infections in AIDS patients in African and Latin American countries are believed to be uncommon. We report the isolation of MAC from cerebrospinal fluid (CSF) of 11 AIDS patients out of 1723 (0.63%) seen at "Centro de Referência e Treinamento - AIDS", São Paulo and discuss the significance of its isolation.

Mycobacterium avium complex (MAC); Cerebrospinal fluid (CSF); Acquired immunodeficiency syndrome (AIDS)

O complexo Mycobacterium avium (CMA) é frequentemente isolado de pacientes com complicações tardias de Síndrome de Imunodeficiência Adquirida (AIDS), especialmente na América do Norte e Europa. Entretanto, existem poucos relatos do isolamento deste complexo a partir do sistema nervoso central (SNC) nestes países. Acredita-se que infecções pelo CMA sejam raras entre pacientes portadores de AIDS em países da África e América Latina. Neste trabalho relatamos o isolamento do CMA do líquor de 11 pacientes portadores de AIDS dentre 1723 (0.63%) atendidos no Centro de Referência e Treinamento -AIDS, de São Paulo, e discutimos a significância deste achado.

MICROBIOLOGY

Mycobacterium avium complex (MAC): an unusual potential pathogen in cerebrospinal fluid of AIDS patients

Complexo Mycobacterium avium: um patógeno potencial pouco comum no líquido céfalo -raquidiano de pacientes com AIDS

David Jamil Hadad^I; Tereza Cristina Petry^II; Anaenza Freie Maresca^III; Lucilaine Ferrazoli^IV; Maria Conceição Martins^IV; Maria Cecilia de Almeida Palhares^V; Walkyria Pereira Pinto^VI; Adauto Castelo Filho^VII; Moises Palaci^IV

^IMédico infectologista do Centro de Referência e Treinamento AIDS (CRTA), Mestre em Doenças Infecciosas e Parasitárias pela Escola Paulista de Medicina

^IIMédico Infectologista do CRTA

^IIIEx-Infectologista do CRTA

^IVPesquisadores Científicos do Setor de Micobactérias do Instituto Adolfo Lutz

^VChefe do Laboratório do CRTA

^VIDiretora Técnica do CRTA

^VIIProfessor Adjunto da Disciplina de Doenças Infecciosas e Parasitárias da Escola Paulista de Medicina

^{Correspondence to} Correspondence to: David Jamil Hadad Rua Dr. Diogo de Faria, 666/35 Vila Clementino, 04037-222 São Paulo, S.P., Brasil

SUMMARY

Mycobacterium avium complex (MAC) is frequently isolated from patients with late complications of Acquired Immunodeficiency Syndrome (AIDS), especially in North America and Europe. However, its isolation from the central nervous system (CNS) has been seldom reported in these countries. MAC infections in AIDS patients in African and Latin American countries are believed to be uncommon. We report the isolation of MAC from cerebrospinal fluid (CSF) of 11 AIDS patients out of 1723 (0.63%) seen at "Centro de Referência e Treinamento - AIDS", São Paulo and discuss the significance of its isolation.

Keywords:Mycobacterium avium complex (MAC); Cerebrospinal fluid (CSF); Acquired immunodeficiency syndrome (AIDS).

RESUMO

O complexo Mycobacterium avium (CMA) é frequentemente isolado de pacientes com complicações tardias de Síndrome de Imunodeficiência Adquirida (AIDS), especialmente na América do Norte e Europa. Entretanto, existem poucos relatos do isolamento deste complexo a partir do sistema nervoso central (SNC) nestes países. Acredita-se que infecções pelo CMA sejam raras entre pacientes portadores de AIDS em países da África e América Latina. Neste trabalho relatamos o isolamento do CMA do líquor de 11 pacientes portadores de AIDS dentre 1723 (0.63%) atendidos no Centro de Referência e Treinamento -AIDS, de São Paulo, e discutimos a significância deste achado.

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ACKNOWLEDGEMENTS

We are grateful to Prof. Dr. Gildo Del Negro, from Faculdade de Medicina - Universidade de São Paulo, for his critical review of this manuscript.

Recebido para publicação em 05/09/1994

Aceito para publicação em 20/09/1994

1. AMERICAN THORACIC SOCIETY. - Mycobacteriosis and the Acquired Immunodeficiency Syndrome. Amer. Rev. resp. Dis., 136: 492-496, 1987.
2. BARRETO, J.A.; PALACI, M. ; FERRAZOLI, L. et al. - Isolation of Mycobacterium avium Complex from bone marrow aspirates of AIDS patients in Brazil. J. infect. Dis., 168: 777-779, 1993.
3. BERENGUER, J.; MORENO, S.; LAGUNA, F. et al. - Tuberculous meningitis in patients infected with human immunodeficiency virus. New Engl. J. Med., 326: 668-672, 1992.
4. CASTELO, A.; GOIHMAN, S.; DALBONI, M.A. et al. - Comparison of daily and twice-weekly regimens to treat pulmonary tuberculosis. Lancet, 2: 1173-1176, 1989.
5. CENTERS FOR DISEASE CONTROL - Diagnosis and management of mycobacterial infection and disease in persons with human immunodeficiency virus infection. Ann. intern. Med., 106: 254-256, 1987.
6. CHAISSON, R.E. & HOPEWELL, P.C.C. - Mycobacteria and AIDS mortality. Amer. Rev. resp. Dis., 139: 1-3, 1989.
7. CHAPMAN, J.S. - The anonymous Mycobacterium in human disease. In: The 6^th Annual Ivan J. Mattson I Memorial Conference of the University of Texas Southwestern Medical School and Dallas Tuberculosis Association. Springfield, Charles C. Thomas, 1960.
8. COKER, R.J.; HELLEYER, T.J.; BROWN, I.N. & WEBER, J.N. - Clinical aspects of mycobacterial infections in HIV infection. Res. Microbiol., 143: 377-381, 1992.
9. COLLINS, F.M. - Mycobacteria as cofactors in AIDS. Res. Microbiol., 143: 369-372, 1992.
10. DAVID, H.; LÉVY-FRÉBAULT, V. & PAPA, F. - Méthodes de Laboratorie pour Mycobactériologie Clinique, Paris. Institut Pasteur, 1986.
11. DAVIDSON, P.T. - The diagnosis and management of disease caused by M. avium complex, M. kansasii, and other mycobacteria. Clin. Chest Med., 10: 431-443, 1989.
12. FOURNIER, A.M.; DICKISON, G.M.; ERDFROCHT, I.R.; CLEARY, T. & FISCHL, M.A. - Tuberculosis and nontuberculous mycobacteriosis in patients with AIDS. Chest, 93: 772-775, 1988.
13. GUTHERTZ, L.S.; DAMSKER, B.; BOTTONE, E.J. et al. - Mycobacterium avium and Mycobacterium intracellulare infections in patients with and without AIDS. J. infect. Dis., 160: 1037-1040, 1989.
14. HAWKINS, C.C.; GOLD, J.W.M.; WHIMBEY, E. et al. - Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann. intern. Med., 105: 184-188, 1986.
15. HOLLANDER, H. - Cerebrospinal fluid normalities and abnormalities in individuals infected with human immunodeficiency virus. J. infect. Dis., 158: 855-858, 1988.
16. HOLT, J.G.; KRIEG, N.R.; SNEATH, P.H.A.; STALEY, J.T. & WILLIAMS, S.T. - The Mycobacteria. In: BERGEY'S manual of determinative bacteriology. Baltimore, Williams & Wilkins, 1994. p.597-603.
17. HORSBURGH Jr., C.R. - Current concepts: Mycohacterium avium infection in the acquired immunodeficiency syndrome. New Engl. J. Med., 324: 1332-1338, 1991.
18. HORSBURGH, Jr., C.R. - Epidemiology of mycobacterial diseases in AIDS. Res. Microbiol., 143: 372-377, 1992.
19. 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.
20. KENT, P.T. & KUBICA, G.P. - Public health Mycobacteriology. Washington, U. S. Department of Health and Human Services, 1985. No. 86-8230.
21. KLATT, E.C.; JENSEN, D.F. & MEYER, P.R. - Pathology of Mycohacterium avium-intracellulare infection in acquired immunodeficiency syndrome. Hum. Path., 18: 709-714, 1987.
22. KLEIN, N.C.; DAMSKER, B. & HIRSCHMAN, S.Z. - Mycobacterial meningitis: retrospective analysis from 1970 to 1983. Amer. J. Med., 79: 29-34, 1985.
23. MARINELLI, D.L.; ALBELDA, S.M.; WILLIANS, T.M. et al. - Nontuberculous mycobacteria in AIDS: clinical, pathologic and radiographic features. Radiology, 160: 77-82, 1986.
24. MASUR, H.; MICHELIS, M.; GREENE, J. et al. - An outbreak of community-acquired Pneumocystis carinii pneumonia. New Engl. J. Med., 305: 1431-1438, 1981.
²⁵
MINISTÉRIO DA SAÚDE. Secretaria Nacional de Ações Básicas de Saúde. Divisão Nacional de Laboratórios de Saúde Pública-Normas técnicas para o diagnóstico das meningitis bacterianas. Brasília, Centro de Documentação do Ministério da Saúde, 1986.
26. MINISTÉRIO DA SAÚDE. Bol. Epidem. AIDS, 6 (2) semana 6 a 9 de 1993.
27. SILVA, E.A.M.; MELLES, C.E.A.; SATO, D.N. et al. - Bacteriological and epidemiological aspects of the diagnosis of Mycohacterium tuberculosis as the etiologic agent of meningitis. Rev. Hosp. S. Paulo Esc. paul. Med., 1: 74-76, 1989.
28. WALLACE, J.M. & HANNAH, J.B. - Mycobacterium aviuni complex in patients with the acquired immunodeficiency syndrome: a clinicopathologic study. Chest, 93: 926-932, 1988.
29. WAYNE, L.G. & SRAMEK, H.A. - Agents of newly recognized or infrequently encountered mycobacterial disease. Clin. Microbiol. Rev., 5: 1-25, 1992.
30. WOLINSKY, E. - Nontuberculous mycobacteria and associated diseases. Amer. Rev. resp. Dis., 119: 107-139, 1979.
31. YOUNG. L.S. - Mycobacterium avium complex infection. J. infect. Dis., 157: 863-867, 1988.

Correspondence to:

David Jamil Hadad

Rua Dr. Diogo de Faria, 666/35

Vila Clementino, 04037-222 São Paulo, S.P., Brasil

Publication Dates

Publication in this collection
22 Feb 2007
Date of issue
Apr 1995

History

Accepted
20 Sept 1994
Received
05 Sept 1994

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

[1] 1. AMERICAN THORACIC SOCIETY. - Mycobacteriosis and the Acquired Immunodeficiency Syndrome. Amer. Rev. resp. Dis., 136: 492-496, 1987.

[2] 2. BARRETO, J.A.; PALACI, M. ; FERRAZOLI, L. et al. - Isolation of Mycobacterium avium Complex from bone marrow aspirates of AIDS patients in Brazil. J. infect. Dis., 168: 777-779, 1993.

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

[4] 4. CASTELO, A.; GOIHMAN, S.; DALBONI, M.A. et al. - Comparison of daily and twice-weekly regimens to treat pulmonary tuberculosis. Lancet, 2: 1173-1176, 1989.

[5] 5. CENTERS FOR DISEASE CONTROL - Diagnosis and management of mycobacterial infection and disease in persons with human immunodeficiency virus infection. Ann. intern. Med., 106: 254-256, 1987.

[6] 6. CHAISSON, R.E. & HOPEWELL, P.C.C. - Mycobacteria and AIDS mortality. Amer. Rev. resp. Dis., 139: 1-3, 1989.

[7] 7. CHAPMAN, J.S. - The anonymous Mycobacterium in human disease. In: The 6^th Annual Ivan J. Mattson I Memorial Conference of the University of Texas Southwestern Medical School and Dallas Tuberculosis Association. Springfield, Charles C. Thomas, 1960.

[8] 8. COKER, R.J.; HELLEYER, T.J.; BROWN, I.N. & WEBER, J.N. - Clinical aspects of mycobacterial infections in HIV infection. Res. Microbiol., 143: 377-381, 1992.

[9] 9. COLLINS, F.M. - Mycobacteria as cofactors in AIDS. Res. Microbiol., 143: 369-372, 1992.

[10] 10. DAVID, H.; LÉVY-FRÉBAULT, V. & PAPA, F. - Méthodes de Laboratorie pour Mycobactériologie Clinique, Paris. Institut Pasteur, 1986.

[11] 11. DAVIDSON, P.T. - The diagnosis and management of disease caused by M. avium complex, M. kansasii, and other mycobacteria. Clin. Chest Med., 10: 431-443, 1989.

[12] 12. FOURNIER, A.M.; DICKISON, G.M.; ERDFROCHT, I.R.; CLEARY, T. & FISCHL, M.A. - Tuberculosis and nontuberculous mycobacteriosis in patients with AIDS. Chest, 93: 772-775, 1988.

[13] 13. GUTHERTZ, L.S.; DAMSKER, B.; BOTTONE, E.J. et al. - Mycobacterium avium and Mycobacterium intracellulare infections in patients with and without AIDS. J. infect. Dis., 160: 1037-1040, 1989.

[14] 14. HAWKINS, C.C.; GOLD, J.W.M.; WHIMBEY, E. et al. - Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann. intern. Med., 105: 184-188, 1986.

[15] 15. HOLLANDER, H. - Cerebrospinal fluid normalities and abnormalities in individuals infected with human immunodeficiency virus. J. infect. Dis., 158: 855-858, 1988.

[16] 16. HOLT, J.G.; KRIEG, N.R.; SNEATH, P.H.A.; STALEY, J.T. & WILLIAMS, S.T. - The Mycobacteria. In: BERGEY'S manual of determinative bacteriology. Baltimore, Williams & Wilkins, 1994. p.597-603.

[17] 17. HORSBURGH Jr., C.R. - Current concepts: Mycohacterium avium infection in the acquired immunodeficiency syndrome. New Engl. J. Med., 324: 1332-1338, 1991.

[18] 18. HORSBURGH, Jr., C.R. - Epidemiology of mycobacterial diseases in AIDS. Res. Microbiol., 143: 372-377, 1992.

[19] 19. 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.

[20] 20. KENT, P.T. & KUBICA, G.P. - Public health Mycobacteriology. Washington, U. S. Department of Health and Human Services, 1985. No. 86-8230.

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

[22] 22. KLEIN, N.C.; DAMSKER, B. & HIRSCHMAN, S.Z. - Mycobacterial meningitis: retrospective analysis from 1970 to 1983. Amer. J. Med., 79: 29-34, 1985.

[23] 23. MARINELLI, D.L.; ALBELDA, S.M.; WILLIANS, T.M. et al. - Nontuberculous mycobacteria in AIDS: clinical, pathologic and radiographic features. Radiology, 160: 77-82, 1986.

[24] 24. MASUR, H.; MICHELIS, M.; GREENE, J. et al. - An outbreak of community-acquired Pneumocystis carinii pneumonia. New Engl. J. Med., 305: 1431-1438, 1981.

[25] ²⁵
MINISTÉRIO DA SAÚDE. Secretaria Nacional de Ações Básicas de Saúde. Divisão Nacional de Laboratórios de Saúde Pública-Normas técnicas para o diagnóstico das meningitis bacterianas. Brasília, Centro de Documentação do Ministério da Saúde, 1986.

[26] 26. MINISTÉRIO DA SAÚDE. Bol. Epidem. AIDS, 6 (2) semana 6 a 9 de 1993.

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

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

[29] 29. WAYNE, L.G. & SRAMEK, H.A. - Agents of newly recognized or infrequently encountered mycobacterial disease. Clin. Microbiol. Rev., 5: 1-25, 1992.

[30] 30. WOLINSKY, E. - Nontuberculous mycobacteria and associated diseases. Amer. Rev. resp. Dis., 119: 107-139, 1979.

[31] 31. YOUNG. L.S. - Mycobacterium avium complex infection. J. infect. Dis., 157: 863-867, 1988.

Brasil