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Disseminated Mycobacterium avium Complex Infection: Clinical Identification and Epidemiologic Trends Joseph A. Havlik, Jr., C. Robert Horsburgh, Jr., Beverly Metchock, Portia P. Williams, S. Alan Fann, and Sumner E. Thompson III

Division ofInftctious Diseases, Department ofMedicine, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine and Grady Memorial Hospital; Division ofHIV/AIDS, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia

Before the proliferation of AIDS, Mycobacterium avium complex (MAC) was an uncommon cause of infection in man; patients with chronic lung disease occasionally acquired MAC pneumonia, but disseminated infection (DMAC) was rare [1, 2]. Early in the AIDS epidemic, it was recognized that persons with advanced human immunodeficiency virus (HIV) infection were at increased risk for MAC infection and that the mycobacterial disease was usually disseminated [3]. A recent report from the Centers for Disease Control indicates that recognition of DMAC in US AIDS patients is increasing [3]. We examined the annual incidence of DMAC in patients in our clinic to determine whether we were experiencing such a trend and to provide insight into the reasons for such increases. Elucidation of the clinical syndrome caused by MAC in patients with AIDS and of the risk factors for its acquisition has been hampered by two factors. The first was the perception that MAC was merely a colonizer and did not contribute to morbidity in AIDS patients [4]; the second was that no effective therapeutic regimens were available [5, 6]. However, recent work has demonstrated that DMAC makes a significant contribution to morbidity in AIDS [7, 8] and that antimycobacterial chemotherapy of DMAC is associated

Received 20 May 1991; revised II November 1991. Presented in part: VI International Conference on AIDS, San Francisco, June 1990 (abstract Th.B515). Patients gave informed consent. Reprints or correspondence: Dr. Joseph A. Havlik, Jr., Infectious Diseases Division, Emory University School of Medicine, 69 Butler St., S.E., Atlanta, GA 30303. The Journal of Infectious Diseases

1992;165:577-80

© 1992 by The University of Chicago. All rights reserved. 0022-1899/92/6503-0029$01.00

with amelioration of symptoms, clearing of MAC from the bloodstream, and in some cases increased survival [3, 9, 10]. Therefore, prompt identification of patients with DMAC is necessary for institution of appropriate therapy. Clinical signs and symptoms referable to DMAC include fever, night sweats, weight loss, diarrhea, anemia, hepatosplenomegaly, and elevated alkaline phosphatase [5, 9, 10]. Because these signs and symptoms are not specific for DMAC and because of concern that DMAC might occur in the absence of these signs and symptoms, the goal of our prospective study was to define the signs and symptoms predictive of DMAC in HIV-seropositive persons. While the clinical syndrome of DMAC may be difficult to recognize in some patients because of the overlap of symptoms with those of other common HIV-associated disease processes, we have outlined a strategy for case identification that will maximize detection ofDMAC and minimize use ofclinical and laboratory resources.

Methods Patients. Grady Memorial Hospital (GMH) is a county hospital serving the greater Atlanta metropolitan area with emphasis on indigent care and is a referral center for HIV-infected persons throughout Georgia. The Infectious Disease Clinic provides outpatient care for these patients. Patients are referred from GMH, from local health departments and other counseling and testing sites, and from private physicians or are self-referred. Epidemiologic analysis. All patients seen at the clinic from December 1985 (when it was established) through December 1990 were included in this analysis. All clinic records of patients were reviewed. In addition, microbiology laboratory records for the same period were reviewed to identify all clinic patients with a positive culture for M. avium. DMAC was diagnosed when a

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To evaluate the incidence of disseminated Mycobacterium avium complex infection (DMAC) and to define the association between signs and symptoms and development of DMAC in patients with human immunodeficiency virus (HIV) infection, all cases ofDMAC at Grady Memorial Hospital Infectious Disease Clinic (Atlanta) between 1985 and 1990 were reviewed, and a prospective study of the association of symptoms with DMAC was done. Between 1985 and 1990, DMAC occurred in 16% of patients with AIDS. Incidence increased from 5.7% in 19851988 to 23.3% in 1989-1990 (P < .001). Median time from AIDS diagnosis to diagnosis of DMAC increased from 4.5 months in 1985-1988 to 8 months in 1989-1990 (P < .02). In the prospective study, DMAC was seen only in persons with a CD4+ count

Disseminated Mycobacterium avium complex infection: clinical identification and epidemiologic trends.

To evaluate the incidence of disseminated Mycobacterium avium complex infection (DMAC) and to define the association between signs and symptoms and de...
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