Published ahead of print on June 23, 2004, doi:10.1164/rccm.200402-162OC Am. J. Respir. Crit. Care Med., Volume 170, Number 7, October 2004, 793-798 A more recent version of this article appeared on October 1, 2004
Submitted on February 10, 2004 Mortality Prediction in Pulmonary Mycobacterium kansasii Infection and Human Immunodeficiency VirusTheodore K Marras1*,1 Department of Medicine and Respirology, University of Toronto, Toronto, ON, Canada, 2 Department of Medicine and Pulmonary and Critical Care, University of Southern California, Los Angeles, CA, USA, 3 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA * To whom correspondence should be addressed. E-mail: ted.marras{at}utoronto.ca.
In the setting of human immunodeficiency virus (HIV) infection, the clinical implications of American Thoracic Society (ATS) diagnostic criteria and the significance of a single positive respiratory culture for Mycobacterium kansasii are unknown. We retrospectively studied HIV-infected patients with pulmonary M. kansasii isolated between 1989 and 2002 at one institution. Of 127 patients, 33% fulfilled ATS disease criteria, 29% received at least 3 active drugs for at least 3 months, and 53% died. In survival analysis, lower CD4 count (HR [95% CI] 1.6 [1.1-2.3]) and positive smear microscopy (2.8 [1.3-6.1]) were associated with mortality, while anti-retroviral therapy (0.3 [0.1-0.8]) and M. kansasii treatment (0.4 [0.2-0.9]) were associated with survival. ATS criteria did not predict mortality (0.9 [0.4-1.9]). Fifteen patients (12%) apparently had indolent infection, not requiring immediate therapy. They had fewer positive cultures and lower rates of positive smear microscopy and ATS-defined disease. In HIV-infected patients with pulmonary M. kansasii infection, predictors of survival include higher CD4 counts, anti-retroviral therapy, negative smear microscopy and adequate treatment for M. kansasii infection, but not ATS diagnostic criteria. Withholding treatment in HIV-infected patients with respiratory M. kansasii isolates should only be considered with negative smear microscopy, few positive cultures and mild immunosuppression. Key words: Guidelines Mycobacterium infections, atypical Survival analysis
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