Disseminated Mycobacterium avium complex infection as a differential diagnosis of tuberculosis in HIV patients
Journal
International Journal of Tuberculosis and Lung Disease
Journal Volume
24
Journal Issue
9
Pages
922-927
Date Issued
2020
Author(s)
Abstract
BACKGROUND: Disseminated Mycobacterium avium complex infection (DMAC) has symptoms and microscopic findings similar to those of TB in HIV patients. To inform a clinical algorithm-based differential diagnosis, we aimed to characterise the clinical features of DMAC. METHODS: This was a retrospective cohort study of 192 HIV-positive patients with culture-confirmed mycobacterial infections hospitalised during 1996–2016 at a major HIV/AIDS treatment centre in Taiwan. RESULTS: HIV patients with DMAC (n ? 58) had a three times higher 1-year mortality than those with TB (n ? 98) (48.3% vs. 16.3%, P, 0.001). DMAC and TB were not distinguishable by the WHO TB screening criteria (fever, cough, night sweats or weight loss). Nevertheless, DMAC was characterised by a lower median CD4 count (5.0 cells/lL vs. 38.5 cells/lL, P, 0.001), lower median body mass index (BMI) (17.7 kg/ m2 vs. 19.7 kg/m2, P ? 0.002) and the absence of chest radiographic findings (P, 0.001). Simultaneous presence of CD4,20 cells/ll, BMI,18.5 kg/m2 and negative chest radiographic finding had a 98% specificity for diagnosing DMAC against TB or other types of mycobacterial infections. CONCLUSION: DMAC is an important differential diagnosis of TB in HIV patients. A simple rule based on CD4, BMI and chest radiography may inform the decision to start anti-DMAC treatment in patients with mycobacterial infection. ? 2020 The Union.
Subjects
Human immunodeficiency virus; Mycobacterium avium complex; Nontuberculous mycobacterium
SDGs
Other Subjects
adult; antiretroviral therapy; Article; atypical mycobacteriosis; bacterium culture; body mass; body weight loss; CD4 lymphocyte count; cohort analysis; controlled study; coughing; differential diagnosis; disseminated Mycobacterium avium complex infection; female; fever; human; Human immunodeficiency virus infection; major clinical study; male; mortality risk; night sweat; priority journal; receiver operating characteristic; retrospective study; sensitivity and specificity; Taiwan; thorax radiography; tuberculosis; wasting syndrome; complication; epidemiology; Mycobacterium avium complex; Mycobacterium tuberculosis; tuberculosis; Diagnosis, Differential; HIV Infections; Humans; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Mycobacterium tuberculosis; Retrospective Studies; Taiwan; Tuberculosis
Publisher
International Union Against Tuberculosis and Lung Disease (The Union)
Type
journal article