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Mycobacterium gordonae: A Treatable Disease in HIV-Positive Patients – Results (1)

We evaluated 15 HIV-negative patients with respiratory secretions positive for M gordonae; no patient had active disease attributable to the organism and therefore specific treatment was not given. The nine radiographic abnormalities could be explained by the underlying disease. Patients 7 and 8 had been treated with medication with potential antituberculosis activity; but the underlying pulmonary disease accounted for all abnormalities (Table 1). There were no positive cultures from extrapulmonary sites. Twelve of those 15 patients had follow-up within the next 12 months and there were no recurrent positive cultures.
The HIV-positive group included 17 patients with AIDS and 4 who did not meet the definition of AIDS (Table 2). Eleven were homosexuals, 8 were intravenous drug users (IVDU), 1 was a homosexual IVDU, and 1 had no known risk factor. Eighteen were male and 3 were female; 11 were white, 3 were black, and 7 were Hispanic. The mean age was 39 years with a range from 26 to 52 years. All HIV-positive patients presented with respiratory symptoms of more than 2 weeks’ duration. Twenty of 21 had fever (except patient 3 in Table 2). The mean CD4+ lymphocyte count of 8 patients was 53 x 10VL (range, 3 to 206 x lOVL).

Table 1—Mycobacterium gordonae in ШУ-Negative Patients

Patient/Age, yr/ Cender/ Race Concomitant Disease Source Chest Radiograph Comment
1/86/MAV COPD, lung carcinoma, radiation pneumonitis BAL Lung infiltrate Improved with cefuroxime
2/85/M/W COPD, diabetes mellitus Sputum 30 colonies Increased interstitial markings Treated for COPD, improved
:V54/MAV Exacerbation of asthma Sputum,tracheal

aspirate

Normal No signs of infection
4/25/FAV Car accident Sputum Not done No signs of infection
5/36/MAV Pneumonia, coagulation disorder Sputum bactec Lung infiltrate with effusion Improved with cefotetan, chest radiograph normal i/ed
6/62/I7II Tul>erculin skin test, COPD Three sputa Normal Responded to cefuroxime
7/46/M/I I Alcohol abuse, ARDS Sputum Bilateral effusions Improved with ticarcillin/clavulanic acid
8/71/F/H Pansinusitis Sputum Normal Improved with ticarcillin/clavulanic acid
9/82/FAV Colon carcinoma Sputum smear +, culture + Normal Treatment with antituberculous medication stopped after identification
10/45/MAV COPD, pneumothorax Sputum, BAL negative Lung infiltrate Resolved with cefuroxime
11/82/M/B Staphylococcus aureus bacteremia and epiglottitis Sputum Minimal fibrosis Improved with oxacillin
12/69/FAV Asthma Sputum smear + Normal Treatment with antituberculous medication stopped after identification
13/71/F/II Bronchitis, chronic renal failure Sputum bactec Increased interstitial markings Improved with cefuroxime
14/73/FAV COPD, bronchitis Sputum 1 colony Hyperinflation Improved with cefuroxime
15/76/M AV COPD, carcinoma Sputum 5 colonies Lung infiltrate (carcinoma) Chemotherapy without complication

Table 2—Mycobacterium gordonae in HIV-Positive Patients

Patient/ Age, xrl Gender/ Race/ Risk Factor PriorDisease ConfoundingFactors Source ChestRadiograph AdditionalFindings Comment
1/35/M/B/homosexual PCP1 Disseminatedcryptococcosis 3 sputa with 20, 22, 30 colonies; bone marrow culture +. synovial fluid of knee 20 colonies Bilateral diffuse interstitial infiltrates, bilateral hilar lymphadenopathy CT with severe hepatomegaly; gallium -1- (see Fig 2) Treated with I, R, P, EMB, CLO, ETH; became afebrile, remained disease free for >6 mo
2/32/M/W/homosexual PCP2 Pulmonary KS, CMY retinitis Blood bactec Diffuse patchy bilateral infiltrates Responded to AMI, ciprofloxacin, died 12 weeks later with presumed PCP
3/28/F/H/IYDU Asthma Sputum bactec Normal PPD +, night sweats I; remained afebrile
4/35/M/H/homosexual PCP1 KS,Pseudomonas

bacteremia

Sputum, BAL 1 colony Bilateralinterstitial

infiltrates

No antituberulous medication; 8 weeks later acute respiratory failure
5/38/F/H/IVDU Seizures Respirator) failure; in BAL few A anitratus Sputum 10 colonies Upper lobes, lingula,cavitary lesions; resolved 4 mo later PPD +, pleuritic chest pain I and antibiotics (gentamicin); remission >9 mo
б/28/MAV/honiosexual giardia, PCP 1 Enterococcusbacteremia Urine 1 colony Perihilarconsolidation Pneumothorax, gallium + in lung and liver Died with acute respirator)’ failure, ARDS
7/39/M/H/IVDU PCP1 Sputum Right lower lung infiltrate No other organism found Cough, never afebrile despite antibiotics, left hospital
8/4 1/MAV/homosexual Cryptococcus Hickman catheter sepsis Stool bactec Normal Gallium + left apex, right paratracheal Improved with I, P,C, ETH, CLO; died 4 months later
9/38/MAV/homosexual DisseminatedKS Sputum 12 colonies Bilateral parahilar infiltrates Supraclavicular lymph node 2-3 cm 6 weeks fever, refused treatment, acute respirator) failure, postmortem lung aspiration with epithelioid cells, mononuclear cells suggestive of granulomas
10/39/M/B/IYDU,homosexual Wastingsyndrome Duodenalaspirate Infiltrates of upper lobes, small right lung nodule Abdominal lymph nodes, gallium with + spleen, + lung Improved with I, R, C, A, ETH for 3 mo; abscesses resolved within 2 mo, died with Candida fungemia
11/43/M/H/IYDU AIDS Pseudomonaspneumonia Sputa smear +, culture+ (3

colonies)

Bilateral patchy lower lobe infiltrates I, R, EMB, CLO, C, ticarcillin/ clavulanic acid; clinical response
12/52/MAY/homosexual PCP1 DisseminatedCMY Sputum 1 colony Normal Gallium hilar and perihilar uptake Unavailable for follow-up
13/37/MAV/homosexual PCP 1, CMY toxoplasmosis Sputum 1 colony, bone marrow granulomas, Bilateral small pleural effusions Several weeks fever without response to antibiotics, Remarkable improvement; symptoms and fever resolved
culturenegative cough, night sweats, chills; gallium + both lungs within 5 days on regimen of I. R, EMB. C, without recurrence for 4 mo; died 6 mo later with Enterococcus bacteremia. PCP
14/40/M AY/IYDl’ Sputum P mirabilis, £ cloacae Sputum smear +(numerous) Bilateral upper lobe infiltrates, small cavity Diarrhea, weight loss Cardiopulmonary arrest 3 days after hospital admission
15/26/M/H/1YDU PCP 1 PCP Stool 1 colony Small apical cavities Discharged from hospital
16/42/MAV/hoim)sexual PCP 1 CMYpneumonia.

PCP

Sputum bactec Bilateralinfiltrates.

resolved

Improved with I. P, C. ETH. CLO; died 4 mo later
17/29/M/H/IVDU Staphylococcusaureus

bacteremia

Sputum 1 colony Cardiomegaly, bilateral lower lung infiltrates Died 5 days later withsepsis
18/39/MAV/honwsexual CMY retinitis Presumed PCP 2 sputa bactec Normal Discharged home
19/34/MAV/homosexual PCP 1 DisseminatedKS,

histoplasmosis

Sputum 1 colony Normal, then ARDS Died 7 days later
20/42/M/B/unknown PCP Stool bactec Bilateralinterstitial

infiltrates

Diarrhea, anorexia Discharged from hospital after trimethoprim/ sulfamethoxazole
21/39/FAV/IYDl’ PCP 2 Klebsiellapneumonia Sputum Left lower lobe infiltrate Discharged from hospital. 4 sputa culture negativ e
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