Mycobacterium avium complex (MAC) isolated from AIDS patients and the criteria required for its implication in disease

Hadad, David Jamil; Palhares, Maria Cecília de Almeida; Placco, Anna Luiza Nunes; Domingues, Carmem Silvia Bruniera; Castelo Filho, Adauto; Ferrazoli, Lucilaine; Ueki, Sueli Yoko Mizuka; Telles, Maria Alice da Silva; Martins, Maria Conceição; Palaci, Moisés

doi:10.1590/S0036-46651995000500001

Abstracts

Before the AIDS pandemia, the Mycobacterium avium complex (MAC) was responsible in most cases for the pneumopathies that attack patients with basic chronic pulmonary diseases such as emphysema and chronic bronchitis36. In 1981, with the advent of the acquired immunodeficiency syndrome (AIDS), MAC started to represent one of the most frequent bacterial diseases among AIDS patients, with the disseminated form of the disease being the major clinical manifestation of the infection8. Between January 1989 and February 1991, the Section of Mycobacteria of the Adolfo Lutz Institute, São Paulo, isolated MAC from 103 patients by culturing different sterile and no-sterile processed specimens collected from 2304 patients seen at the AIDS Reference and Training Center and/or Emilio Ribas Infectology Institute. Disseminated disease was diagnosed in 29 of those patients on the basis of MAC isolation from blood and/or bone marrow aspirate. The other 74 patients were divided into categories highly (5), moderately (26) and little suggestive of disease (43) according to the criteria of DAVIDSON (1989)10. The various criteria for MAC isolation from sterile and non-sterile specimens are discussed.

Mycobacterium avium complex (MAC); Acquired immunodeficiency syndrome (AIDS); Diagnostic criteria

Anterior a pandemia de AIDS, o Complexo Mycobacterium avium (MAC) era responsável pela maioria das vezes, por pneumopatias acometendo pacientes com doença pulmonar crônica de base como enfisema e bronquite crônica36. Em 1981, com o advento da síndrome de imunodeficiência adquirida (SIDA), o MAC passou a representar uma das doenças bacterianas mais frequentes em pacientes com esta síndrome, sendo a doença disseminada a principal forma de manifestação clínica da infecção8. Entre Janeiro de 1989 e Fevereiro de 1991, no Setor de Micobactérias do Instituto Adolfo Lutz em São Paulo, o MAC foi isolado de 103 pacientes a partir do cultivo de diferentes espécimes estéreis e não estéreis processados, coletados de 2.304 pacientes atendidos no Centro de Referência e Treinamento AIDS e/ou Instituto de Infectologia Emilio Ribas. A doença disseminada foi diagnosticada em 29 destes, com base no isolamento do MAC a partir do sangue e/ou aspirado de medula óssea. Os outros 74 pacientes foram agrupados nas categorias altamente (5), moderadamente (26) e pouco sugestiva de doença (43) de acordo com os postulados de DAVIDSON (1989)10. Os diferentes critérios para valorizar o seu isolamento de espécimes estéreis e não estéreis são discutidos.

MICROBIOLOGY

Mycobacterium avium complex (MAC) isolated from AIDS patients and the criteria required for its implication in disease

Complexo Mycobacterium avium (MAC) isolado de pacientes com AIDS e os critérios exigidos para sua implicação em doença

David Jamil Hadad^I; Maria Cecília de Almeida Palhares^II; Anna Luiza Nunes Placco^III; Carmem Silvia Bruniera Domingues^IV; Adauto Castelo Filho^V; Lucilaine Ferrazoli^VI; Sueli Yoko Mizuka Ueki^VI; Maria Alice da Silva Telles^VI; Maria Conceição Martins^VI; Moisés Palaci^VI

^IHolder of Master's degree in Infectious and Parasitic Diseases, Escola Paulista de Medicina (EPM), and infectologist physician at the AIDS Reference and Training Center (CRTA)

^IIHead of the CRTA laboratory

^IIIHolder of a degree in Biomedicine, CRTA laboratory

^IVResponsible for the AIDS Epidemiologic Alert Center (CVE) of the Health Secretariat of the State of São Paulo

^VAssociate Professor, Discipline in Infectious and Parasitic Diseases, EPM

^VIScientific researcher, Sector of Mycobacteria, Adolfo Lutz Institute

^{Correspondence to} Correspondence to: David Jamil Hadad Rua Antonio Carlos 122 01309-010, São Paulo, SP, Brasil

SUMMARY

Before the AIDS pandemia, the Mycobacterium avium complex (MAC) was responsible in most cases for the pneumopathies that attack patients with basic chronic pulmonary diseases such as emphysema and chronic bronchitis³⁶. In 1981, with the advent of the acquired immunodeficiency syndrome (AIDS), MAC started to represent one of the most frequent bacterial diseases among AIDS patients, with the disseminated form of the disease being the major clinical manifestation of the infection⁸. Between January 1989 and February 1991, the Section of Mycobacteria of the Adolfo Lutz Institute, São Paulo, isolated MAC from 103 patients by culturing different sterile and no-sterile processed specimens collected from 2304 patients seen at the AIDS Reference and Training Center and/or Emilio Ribas Infectology Institute. Disseminated disease was diagnosed in 29 of those patients on the basis of MAC isolation from blood and/or bone marrow aspirate. The other 74 patients were divided into categories highly (5), moderately (26) and little suggestive of disease (43) according to the criteria of DAVIDSON (1989)¹⁰. The various criteria for MAC isolation from sterile and non-sterile specimens are discussed.

Keywords:Mycobacterium avium complex (MAC); Acquired immunodeficiency syndrome (AIDS); Diagnostic criteria.

RESUMO

Anterior a pandemia de AIDS, o Complexo Mycobacterium avium (MAC) era responsável pela maioria das vezes, por pneumopatias acometendo pacientes com doença pulmonar crônica de base como enfisema e bronquite crônica³⁶. Em 1981, com o advento da síndrome de imunodeficiência adquirida (SIDA), o MAC passou a representar uma das doenças bacterianas mais frequentes em pacientes com esta síndrome, sendo a doença disseminada a principal forma de manifestação clínica da infecção⁸.

Entre Janeiro de 1989 e Fevereiro de 1991, no Setor de Micobactérias do Instituto Adolfo Lutz em São Paulo, o MAC foi isolado de 103 pacientes a partir do cultivo de diferentes espécimes estéreis e não estéreis processados, coletados de 2.304 pacientes atendidos no Centro de Referência e Treinamento AIDS e/ou Instituto de Infectologia Emilio Ribas. A doença disseminada foi diagnosticada em 29 destes, com base no isolamento do MAC a partir do sangue e/ou aspirado de medula óssea. Os outros 74 pacientes foram agrupados nas categorias altamente (5), moderadamente (26) e pouco sugestiva de doença (43) de acordo com os postulados de DAVIDSON (1989)¹⁰. Os diferentes critérios para valorizar o seu isolamento de espécimes estéreis e não estéreis são discutidos.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGEMENTS

We are grateful to Prof. Dr. Gildo Del Negro from "Disciplina de Moléstias Infecciosas da Faculdade de Medicina da Universidade de São Paulo" for his critical review of the manuscript.

Recebido para publicação em 12/04/1995

Aceito para publicação em 15/09/1995

1. AHN, C.H.; MCLARTY, J.W.; AHN, S.S. et al. - Diagnostic criteria for pulmonary disease caused by Mycobacterium kansasii and Mycobacterium intracellulare. Amer. Rev. resp. Dis., 125: 388-391, 1982.
2. AMERICAN THORACIC SOCIETY - Diagnostic standards and classification of Tuberculosis and other Mycobacterial diseases. 14^thed. Amer. Rev. resp. Dis., 123: 343-358, 1981.
3. AMERICAN THORACIC SOCIETY - Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Amer. Rev. resp. Dis., 142: 940-953, 1990.
4. BARRETO, J.A.; PALACI, M.; FERRAZOLI, L. et al. - Isolation of Mycobacterium avium complex from bone marrow aspirates of AIDS patients in Brasil. J. infect. Dis., 168: 777-779, 1993.
5. CHAPMAN, J.S. - The anonymous Mycobacterium in human disease. In: The 6^th Annual Ivan J. Maltson I Memorial Conference of the University of Texas Southwestern Medical School and Dallas Tuberculosis Association. Springfield, Charles C. Thomas, 1960.
6. CHAPMAN, J.S. - The ecology of the atypical Mycobacteria. Arch. environm. Hlth., 22: 41-46, 1971.
7. CHIN, D.P.; HOPEWELL, P.C.; YAJKO, D.M. et al. - Mycobacterium avium complex (MAC) in the respiratory or gastrointestinal tract precedes MAC bacteremia. Denver Front. Mycobacteriol., 1992. p. 15.
8. COKER, R.J.; HELLYER, T.J.; BROWN, I.N. et al. - Clinical aspects of mycobacterial infections in HIV infection. Res. Microbiol., 143: 377-381, 1992.
9. DAVID, H.; LEVY-FREBAULT, V. & THOREL, M.F. - Méthodes de laboratoire pour mycobactériologie clinique. Unite de la Tuberculose et des mycobactéries. Paris, Institut Pasteur, 1989.
10. 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.
11. DAWSON, D.J.; ARMSTRONG, J.G. & BLACKLOCK, Z.M. - Mycobacterial cross-contamination of bronchoscopy specimens. Amer. Rev. resp. Dis., 126: 1095-1097, 1982.
12. EDWARDS, L.B. & PALMER, C.E. - Isolation of "atypical" mycobacteria from healthy persons. Amer. Rev. resp. Dis., 80: 747-749, 1959.
13. EDWARDS, F.G.B. - Disease caused by "atypical" (opportunist) mycobacteria: a whole population review. Tubercle, 51: 285-295, 1970.
14. FERRAZOLI, L.; SILVA, E.A.M.; MARTINS, M.C. et al. - Micobactérias outras que năo o Mycobacterium tuberculosis. Análise da ocorręncia e de aspectos relevantes ao diagnóstico da infecçăo. Hansenol. int., 17: 15-20, 1992.
15. GRAHAM JR., L.; WARREN, N.G.; TSANG, A.Y. et al. - Mycobacterium avium Complex Pseudobacteriuria from a hospital water supply. J. clin. Microbiol., 26: 1034-1036, 1988.
16. HADAD, D.J.; PETRY, T.C.; MARESCA, A.F. et al. - Mycobacterium avium Complex (MAC): an unusual potential pathogen in cerebrospinal fluid. Rev. Inst. Med. trop. S. Paulo, 37: 1-6, 1995.
17. HAWKINS, C.C.; GOLD, J.W.M.; WHIMBLEY, E. et al. - Mycobacterium avium Complex infections in patients with the acquired immunodeficiency syndrome. Ann. intern. Med., 105: 184-188, 1986.
18. HORSBURGH, C.R.; MASON III, U.G.; FARHI, D.C. et al. - Disseminated infection with Mycobacterium avium-intracellulare: a report of 13 cases and a review of the literature. Medicine (Baltimore), 64: 36-48, 1985.
19. HORSBURGH, C.R. - Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. New Engl. J. Med., 324: 1332-1338, 1991.
20. INDERLIED, C.B.; KEMPER, C.A.; BERMUDEZ, L.E.M. - The Mycobacterium avium Complex. Clin. Microbiol. Rev., 6: 266-310, 1993.
21. JACOB, C.N.; HENEIN, S.S.; HEURICH, A.E. et al. - Nontuberculous mycobacterial infection of the central nervous system in patients with AIDS. Sth. med. J. (Bgham, Ala.) 86: 638-640, 1993.
22. KENT, P.T. & KUBICA, G.P. - Public health mycobacteriology - a guide for level III laboratory Atlanta, Centers for Disease Control, 1985. (publication nş PB 86 - 216546).
23. KERLIKOWSKE, K.M. & KATZ, M.H. - Mycobacterium avium Complex and Mycobacterium tuberculosis in patients infected with the human immunodeficiency virus. West. J. Med., 157: 144-148, 1992.
24. KIEHN, T.E.; EDWARDS, F.F.; BRANNON, P. et al. - Infections caused by M. avium complex in immunocompromised patients: diagnosis by blood culture and fecal examination, antimicrobial susceptibility test and morphological and serological characteristics. J. clin. Microbiol., 21: 168-173, 1985.
25. MARINELLI, D.L.; ALBELDA, S.M.; WILLIAMS, T.M. et al. - Nontuberculous mycobacterial infection in AIDS: clinical, pathologic, and radiologic features. Radiology, 160: 77-82, 1986.
26. MILLS, C.C. - Occurrence of Mycobacterium other than Mycobacterium tuberculosis in the oral cavity and in sputum. Appl. Microbiol., 24: 307-310, 1972.
27. MINISTÉRIO DA SAÚDE - Secretaria Nacional de Programas Especiais de Saúde. Divisăo Nacional de Pneumologia Sanitária. Programa Nacional de Controle da Tuberculose. Manual de bacteriologia da tuberculose. 1980.
28. PORTAELS, F.; LARSSON, L. & SMEETS, P. - Isolation of mycobacteria from healthy persons' stools. Int. J. Leprosy, 56: 468-471, 1988.
29. SATHE, S.S. & REICHMAN, L.B. - Mycobacterial disease in patients infected with the human immunodeficiency virus. Clin. Chest Med., 10: 445-463, 1989.
30. SNIDER, W.; SIMPSON, D.M.; NIELSEN, S. et al. - Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients. Ann. Neurol., 14: 403-418, 1983.
31. STEWART, D.J. & BADEY, G.P. - Infections in hairy cell leukemia (leukemic reticuloendotheliosis). Cancer, 47: 801-805, 1981.
32. TSUKAMURA, M - Screening for atypical mycobacteria. Tubercle, 51: 280-284, 1970.
33. TSUKAMURA, M. - Diagnosis of non-tuberculous mycobacteriosis. In: CASAL. M., ed. Mycobacteria of clinical interest. Amsterdam, Elsevier Science, 1986. p. 251-263.
34. 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.
35. WHIMBLEY, E.; KIEHN, T.E. & ARMSTRONG, D. - Disseminated Mycobacterium avium-intrucellulare disease: diagnosis and therapy. Curr. clin. Top. infect. Dis., 7: 112-133, 1988.
36. WOLINSKY, E. - Nontuberculous mycobacteria and associated diseases. Amer. Rev. resp. His., 119: 107-159, 1979.
37. WOLINSKY, E. - When is an infection disease? Rev. infect. Dis., 3: 1025-1027, 1981.
38. WOLINSKY, E. - Mycobacterial diseases other than tuberculosis. Clin. infect. Dis., 15: 1-12, 1992.
39. YAMAMOTO, M.; OGURA, Y.; SUDO, K. et al. - Diagnostic criteria for disease caused by atypical mycobacteria. Amer. Rev. resp. Dis., 96: 773-778, 1967.

Correspondence to:

David Jamil Hadad

Rua Antonio Carlos 122

01309-010, São Paulo, SP, Brasil

Publication Dates

Publication in this collection
21 Sept 2006
Date of issue
Oct 1995

History

Received
12 Apr 1995
Accepted
15 Sept 1995

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

[1] 1. AHN, C.H.; MCLARTY, J.W.; AHN, S.S. et al. - Diagnostic criteria for pulmonary disease caused by Mycobacterium kansasii and Mycobacterium intracellulare. Amer. Rev. resp. Dis., 125: 388-391, 1982.

[2] 2. AMERICAN THORACIC SOCIETY - Diagnostic standards and classification of Tuberculosis and other Mycobacterial diseases. 14^thed. Amer. Rev. resp. Dis., 123: 343-358, 1981.

[3] 3. AMERICAN THORACIC SOCIETY - Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Amer. Rev. resp. Dis., 142: 940-953, 1990.

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

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

[6] 6. CHAPMAN, J.S. - The ecology of the atypical Mycobacteria. Arch. environm. Hlth., 22: 41-46, 1971.

[7] 7. CHIN, D.P.; HOPEWELL, P.C.; YAJKO, D.M. et al. - Mycobacterium avium complex (MAC) in the respiratory or gastrointestinal tract precedes MAC bacteremia. Denver Front. Mycobacteriol., 1992. p. 15.

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

[9] 9. DAVID, H.; LEVY-FREBAULT, V. & THOREL, M.F. - Méthodes de laboratoire pour mycobactériologie clinique. Unite de la Tuberculose et des mycobactéries. Paris, Institut Pasteur, 1989.

[10] 10. 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.

[11] 11. DAWSON, D.J.; ARMSTRONG, J.G. & BLACKLOCK, Z.M. - Mycobacterial cross-contamination of bronchoscopy specimens. Amer. Rev. resp. Dis., 126: 1095-1097, 1982.

[12] 12. EDWARDS, L.B. & PALMER, C.E. - Isolation of "atypical" mycobacteria from healthy persons. Amer. Rev. resp. Dis., 80: 747-749, 1959.

[13] 13. EDWARDS, F.G.B. - Disease caused by "atypical" (opportunist) mycobacteria: a whole population review. Tubercle, 51: 285-295, 1970.

[14] 14. FERRAZOLI, L.; SILVA, E.A.M.; MARTINS, M.C. et al. - Micobactérias outras que năo o Mycobacterium tuberculosis. Análise da ocorręncia e de aspectos relevantes ao diagnóstico da infecçăo. Hansenol. int., 17: 15-20, 1992.

[15] 15. GRAHAM JR., L.; WARREN, N.G.; TSANG, A.Y. et al. - Mycobacterium avium Complex Pseudobacteriuria from a hospital water supply. J. clin. Microbiol., 26: 1034-1036, 1988.

[16] 16. HADAD, D.J.; PETRY, T.C.; MARESCA, A.F. et al. - Mycobacterium avium Complex (MAC): an unusual potential pathogen in cerebrospinal fluid. Rev. Inst. Med. trop. S. Paulo, 37: 1-6, 1995.

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

[18] 18. HORSBURGH, C.R.; MASON III, U.G.; FARHI, D.C. et al. - Disseminated infection with Mycobacterium avium-intracellulare: a report of 13 cases and a review of the literature. Medicine (Baltimore), 64: 36-48, 1985.

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

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

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

[22] 22. KENT, P.T. & KUBICA, G.P. - Public health mycobacteriology - a guide for level III laboratory Atlanta, Centers for Disease Control, 1985. (publication nş PB 86 - 216546).

[23] 23. KERLIKOWSKE, K.M. & KATZ, M.H. - Mycobacterium avium Complex and Mycobacterium tuberculosis in patients infected with the human immunodeficiency virus. West. J. Med., 157: 144-148, 1992.

[24] 24. KIEHN, T.E.; EDWARDS, F.F.; BRANNON, P. et al. - Infections caused by M. avium complex in immunocompromised patients: diagnosis by blood culture and fecal examination, antimicrobial susceptibility test and morphological and serological characteristics. J. clin. Microbiol., 21: 168-173, 1985.

[25] 25. MARINELLI, D.L.; ALBELDA, S.M.; WILLIAMS, T.M. et al. - Nontuberculous mycobacterial infection in AIDS: clinical, pathologic, and radiologic features. Radiology, 160: 77-82, 1986.

[26] 26. MILLS, C.C. - Occurrence of Mycobacterium other than Mycobacterium tuberculosis in the oral cavity and in sputum. Appl. Microbiol., 24: 307-310, 1972.

[27] 27. MINISTÉRIO DA SAÚDE - Secretaria Nacional de Programas Especiais de Saúde. Divisăo Nacional de Pneumologia Sanitária. Programa Nacional de Controle da Tuberculose. Manual de bacteriologia da tuberculose. 1980.

[28] 28. PORTAELS, F.; LARSSON, L. & SMEETS, P. - Isolation of mycobacteria from healthy persons' stools. Int. J. Leprosy, 56: 468-471, 1988.

[29] 29. SATHE, S.S. & REICHMAN, L.B. - Mycobacterial disease in patients infected with the human immunodeficiency virus. Clin. Chest Med., 10: 445-463, 1989.

[30] 30. SNIDER, W.; SIMPSON, D.M.; NIELSEN, S. et al. - Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients. Ann. Neurol., 14: 403-418, 1983.

[31] 31. STEWART, D.J. & BADEY, G.P. - Infections in hairy cell leukemia (leukemic reticuloendotheliosis). Cancer, 47: 801-805, 1981.

[32] 32. TSUKAMURA, M - Screening for atypical mycobacteria. Tubercle, 51: 280-284, 1970.

[33] 33. TSUKAMURA, M. - Diagnosis of non-tuberculous mycobacteriosis. In: CASAL. M., ed. Mycobacteria of clinical interest. Amsterdam, Elsevier Science, 1986. p. 251-263.

[34] 34. 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.

[35] 35. WHIMBLEY, E.; KIEHN, T.E. & ARMSTRONG, D. - Disseminated Mycobacterium avium-intrucellulare disease: diagnosis and therapy. Curr. clin. Top. infect. Dis., 7: 112-133, 1988.

[36] 36. WOLINSKY, E. - Nontuberculous mycobacteria and associated diseases. Amer. Rev. resp. His., 119: 107-159, 1979.

[37] 37. WOLINSKY, E. - When is an infection disease? Rev. infect. Dis., 3: 1025-1027, 1981.

[38] 38. WOLINSKY, E. - Mycobacterial diseases other than tuberculosis. Clin. infect. Dis., 15: 1-12, 1992.

[39] 39. YAMAMOTO, M.; OGURA, Y.; SUDO, K. et al. - Diagnostic criteria for disease caused by atypical mycobacteria. Amer. Rev. resp. Dis., 96: 773-778, 1967.

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