EPIDEMIOLOGY OF NONTUBERCULOUS MYCOBACTERIUM FROM AN INNER-CITY PHILADELPHIA HOSPITAL IN PATIENTS WITH HIV

Abstract

SESSION TITLE: Chest Infections 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: MAC is the most common pathogen of Nontuberculous Mycobacterium (NTM) that is known to cause disease in HIV infected individuals. However, patients with MAC and other NTM species are at greatest risk of developing disease as CD4 cell counts fall below 50 cells/mm3. This study was done to help determine the incidence of NTM in inner Philadelphia in those with known HIV infections and the risk of disease at the CD4 level. METHODS: We conducted a retrospective study of patients with known HIV infection who had a AFB culture positive from 2016 to 2017. Patients with blood cultures or tissue biopsy positive for NTM were concluded to have disease; respiratory disease was considered if they met ATS guidelines: 1. chest radiograph or, in the absence of cavitation, chest high-resolution computed tomography; 2. Positive cultures from sputum samples or one bronchial wash; and 3. Exclusion of other disorders, such as TB. The data was collected from cultures at Hahnemann University Hospital in Philadelphia. This was an IRB study. RESULTS: From 2016-2017, there were 87 total patients who were NTM culture positive of which 26 had HIV/AIDS and 22 were determined to have NTM infections. The average age was 46, out of the 22 patients 14 were males and 8 females, and 20 were black and 2 were white. There were 16 patients who had respiratory disease with the most common NTM being MAC in 14 cultures, and there were 3 other cultures which grew M. chelonae, M. bolletii or M. litoral. 7 patients were found to be bacteremic with 6 being MAC positive and 1 growing M. abscesses; and 4 patients had NTM infection of a GI source with all 4 growing MAC. 5 of the 7 patients with NTM bacteremia also had growth in respiratory or GI cultures. The average CD4 count for those with respiratory infections was 130, not including one patient with a CD4 level of 1362. Those who were or also had bacteremia had an average CD4 count of 36. The average CD4 count of those with a GI source was 6. There were several patients who had multiple sources of NTM culture positivity. CONCLUSIONS: HIV infected patients are at an increased risk of disease from MAC compared to other NTM species in non-HIV infected patients. Patients with CD4 counts <50 cells/mm3 can be at higher risk of disseminated and GI disease; however those with higher CD4 counts are still at risk of respiratory disease. CLINICAL IMPLICATIONS: Based on the demographics of this study, in Philadelphia, black patients are at the greatest risk of NTM disease most likely secondary to . Patients with HIV/AIDS should be assessed for NTM infections even if their CD4 counts are >100 cells/mm3. DISCLOSURES: No relevant relationships by Ekamjeet Randhawa, source=Web Response No relevant relationships by Michael Stephen, source=Web Response