Avium Intracellulare Research Articles

Patchy uptake of gallium in the lungs of AIDS patients with atypical mycobacterial infection.

The gallium scans of seven AIDS patients who cultured positive for atypical mycobacterium were reviewed. Six cultured positive for Mycobacterium avium intracellulare, while one for Mycobacterium xenopi. A patchy uptake pattern of gallium in the lungs of these patients was identified.

The presence of novel glucuronic acid-containing, type-specific glycolipid antigens within Mycobacterium spp. Revision of earlier structures.

Previously, we had described the structures of the haptenic oligosaccharides of the surface glycopeptidolipid antigens from serotypes 9 and 25 of the Mycobacterium avium complex and had synthesized these units as putative antigenic probes. The lack of chemical concordance between the synthetic products and the haptens has prompted a re-examination of these structures utilizing the instrumental techniques not previously available of fast atom bombardment-mass spectrometry, Fourier transform infra-red, and high resolution NMR spectroscopy. With the additional information thus available, more extensive chemical fragmentations by base degradation, followed by alkylation, have furnished supportive evidence to allow formulation of revised and novel structures, all of which contain glucuronic acid: serotype 9, 2,3-di-O-Me-L-Fucp(alpha 1----4)-D-GlcAp(beta 1----4)-2,3-di-O-Me-L-Fucp(alpha 1----3)-L-Rhap(alpha 1----2)-6dTal; and serotype 25, 4-acetamido-4,6-dideoxy-2-O-Me-hexosyl(alpha 1----4)-D- GlcAp(beta 1----4)2-O-Me-L-Fucp(alpha 1----3)-L-Rhap(alpha 1----2)6dTal. Glucuronic acid, acetamido sugars, and other novel sugars appear to be widespread in the glycopeptidolipid antigens of Mycobacterium spp. The revised structures will allow renewed synthesis of artificial antigen probes and rational approaches to preparing monoclonal antibodies, both necessary for the new diagnostics required to trace the sources of widespread infections due to M. avium and Mycobacterium intracellulare.

Kaposi's sarcoma and acquired immunodeficiency syndrome: Postmortem findings in twenty-four cases

Autopsy results on twenty-four patients with acquired immunodeficiency syndrome (AIDS) and Kaposi's sarcoma were reviewed. At postmortem, 29% of patients had evidence of visceral Kaposi's sarcoma without skin lesions. The most common sites for visceral involvement with Kaposi's sarcoma were as follows: lung (37%), gastrointestinal tract (50%), and lymph nodes (50%). At the time of death, only 25% of patients had evidence of cutaneous disease alone. The patients survived up to 36 months after the diagnosis of AIDS was made according to the specific diagnostic criteria established by the Centers for Disease Control. Many of the patients had severe, disseminated infections during the course of their AIDS illness. The most common infections diagnosed during the patients' clinical courses and/or at autopsy were cytomegalovirus (75%), candidiasis (50%), Mycobacterium avium intracellulare (50%), Pneumocystis carinii pneumonia (50%), bacterial pneumonia (33%), and herpes simplex virus (29%). Nearly 80% of the deaths were attributed to infection. In only one case was overwhelming Kaposi's sarcoma determined to be the cause of death.

Childhood lymphadenitis in a harsh northern climate due to atypical mycobacteria.

Between 1979 and 1983, 16 patients under 15 years of age living within 480 km of Edmonton, Alberta (latitude 53 degrees 34' N) were seen with cervical lymphadenitis caused by atypical mycobacteria. During this period only 4 cases of cervical lymphadenitis from Mycobacterium tuberculosis occurred in the same age and geographical grouping. Young children age 1-4 years accounted for most cases (14/16). The onset showed no seasonal preponderance and the nodal enlargement was either asymptomatic (8/16) or associated with only minor systemic symptoms. M. avium intracellulare scrofulaceum (6 cases) or M. avium intracellulare (4 cases) were identified on cultures from the infected node. In the remaining cases characteristic histopathology and acid fast bacilli were seen on biopsy specimens but no organisms could be cultured. Surgery was employed in all cases either for diagnosis or for therapy. This series demonstrates that atypical mycobacteria may cause childhood lymphadenitis throughout the year in a harsh inland Northern climate. The etiological pathogen can be difficult to culture but complete surgical excision of the infected node is usually curative.

Effect of oral exposure ofMycobacterium avium intracellular on the protective immunity induced by BCG

The relative protective efficacy of oral administration of mycobacteria as compared to the conventional intradermal route of vaccination has been assessed in guinea pigs. Skin test reactivity to partially purified protein derivative and protective immunity to challenge with virulent Mycobacterium tuberculosis were used as parameters of protective immunity. Oral immunisation of guinea pigs either with BCG or with Mycobacterium avium intracellulare induces skin test reactivity and protective immunity comparable to that induced by intradermal route of vaccination. Oral exposure of Mycobacterium avium intracellulare prior to oral or intradermal dose of BCG did not interfere with the protective immunity induced by BCG in guinea pigs challenged with Mycobacterium tuberculosis H37Rv.

Pathologic features of the liver in acquired immune deficiency syndrome (AIDS).

The livers of 26 adult males with acquired immune deficiency syndrome (AIDS) were reviewed. The occurrence of portal tracts with diminished lymphocytes, probably reflecting generalized exhaustion of the lymphoid system, was a characteristic morphologic change, and was found in all cases. Kupffer cell hyperplasia was also a frequent finding and probably reflected generalized infection(s). Punched-out clusters of foamy histiocytes filled with acid-fast bacilli, typical for infection with Mycobacterium avium intracellulare (MAC), were found in three patients. In addition, MAC was cultured from two livers without the foamy histiocytic changes. Chronic viral hepatitis (three cases) and deposition of polarizable materials (one case) in the liver might be related to unusual habits of patients with AIDS. In conclusion, livers from patients with AIDS disclosed several kinds of lesions reflecting underlying or associated conditions in AIDS, but these did not contribute to the cause of death in our patients.

Oral manifestation of disseminated mycobacterium avium intracellulare in a patient with aids

The acquired immune deficiency syndrome (AIDS) is characterized by a selective suppression of the immune system that renders patients susceptible to infection by a variety of opportunistic organisms. Among these is Mycobacterium avium intracellulare. AIDS victims often have oral manifestations of Kaposi's sarcoma and candidiasis. This article reports an unusual oral presentation of disseminated infection with Mycobacterium avium intracellulare in a patient with AIDS.

Diagnosis of pulmonary disease in acquired immune deficiency syndrome (AIDS). Role of bronchoscopy and bronchoalveolar lavage.

The effectiveness of fiberoptic bronchoscopy with the addition of bronchoalveolar lavage (BAL) was evaluated in 72 patients with the acquired immune deficiency syndrome (AIDS) and parenchymal pulmonary disease. The diagnostic yield varied for different pathogens and was 94% (45/48 cases) for Pneumocystis carinii, 67% (14/21 cases) for cytomegalovirus, and 62% (8/13 cases) for Mycobacterium avium intracellulare. Of the 11 cases of documented Kaposi's sarcoma in the lung parenchyma, none were diagnosed from bronchoscopy, although characteristic endobronchial lesions were seen in 6 cases. Overall, the yield of bronchoscopy for all pathogens was 65%. Both transbronchial biopsy and BAL had high independent yields (88 and 85%, respectively) for diagnosing P. carinii pneumonia but combining the procedures gave the best yield. Cytomegalovirus was most often diagnosed from examination and culture of the BAL. Recovery of Mycobacterium avium intracellulare was highest with culture of both washings and lavage. Neither granuloma nor organisms were seen on examination of histologic specimens. Bronchoscopy with BAL was well tolerated with few complications even in 5 patients with thrombocytopenia and 10 patients requiring mechanical ventilation. Sixteen patients (22%) had an increase in temperature after the procedure without hypotension or sepsis and 1 patient (1.5%) had a moderate pulmonary hemorrhage after transbronchial biopsy. Fiberoptic bronchoscopy with BAL is a safe procedure with a high diagnostic yield in AIDS patient with lung disease.

B CELL ABNORMALITIES IN CHILDREN WITH AIDS

B cell abnormalities have recently been described in adults with the Acquired Immunodeficiency Syndrome. Immunological profiles were performed in 19 children with AIDS or its prodromal stage. Opportunistic infections in AIDS patients included disseminated cytomegalovirus, invasive candidiasis, pneumocystis carinii, pneumonia and systemic mycobacterium avium intracellulare. Hypergammaglobulinemia was documented in 6 of 7 children with AIDS and in all prodromes specific antibody responses to tetanus immunization were extremely low or undetectable in 5 of 6 prodromes and in 4 of 5 children with opportunistic infections. Mitogenic responses to phytohemagglutinin were normal in 6 of 7 AIDS infants and 11 of 12 prodromes. Pokeweed mitogen responses were depressed or absent in all patients with prodrome and in 6 of 7 with AIDS. The combination of hypergammaglobulinemia, poor specific antibody responses and depressed pokeweed mitogen responses suggest that B cell abnormalities are found in childhood AIDS, and are similar to those found in adults with the syndrome. Supported by NIH Grant Number: 1 U01 AI 20671-01

Gastrointestinal Cytomegalovirus Infection in a Homosexual Man With Severe Acquired Immunodeficiency Syndrome

A 44-yr-old white homosexual man with a history of Pneumocystis carinii pneumonia developed watery diarrhea and fever. Flexible sigmoidoscopy revealed yellow plaques in the sigmoid colon suggestive of pseudomembranous colitis. Stool examination for ova and parasites, Clostridium difficile toxin, and cultures for pathogens, including Clostridium difficile, were negative. Infection with multiple organisms, including Mycobacterium avium intracellulare, Toxoplasma gondii, herpes simplex, and cytomegalovirus, was demonstrated. Postmortem examination showed esophageal and colonic ulcerations with cytomegalic inclusions, and cytomegalovirus was cultured from the colonic lesions. This report describes a case of disseminated cytomegalovirus infection with esophageal and colonic involvement in a homosexual man with the acquired immunodeficiency syndrome.

Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients.

Fifty patients with acquired immune deficiency syndrome had complications affecting the central or peripheral nervous systems or both. The patients were either male homosexuals, intravenous drug abusers, or recently arrived Haitian refugees. They ranged in age from 25 to 56. Central nervous system complications were of four kinds: (1) Infections included Toxoplasma gondii abscesses in 5 patients, progressive multifocal leukoencephalopathy in 2, cryptococcal meningitis in 2, Candida albicans in 1, and possible Mycobacterium avium intracellulare in 3. Eighteen patients suffered a subacute encephalitis possibly attributable to cytomegalovirus infection. (2) Tumors consisted of primary lymphoma of the brain in 3 patients and meningeal invasion by systemic lymphoma in 4. (3) Vascular complications included nonbacterial thrombotic endocarditis in 2 patients and cerebral hemorrhages in the setting of thrombocytopenia in 3. (4) Undiagnosed central nervous system problems were evidenced as focal brain lesions in 3 patients and self-limiting aseptic meningitis in 4. Peripheral neuropathy occurred in 8 patients.

Evidence for plasmid-mediated restriction-modification in Mycobacterium avium intracellulare.

Mycobacterium avium intracellulare strain LR25 carries three plasmids with molecular weights of 11.2, 18.3 and 107 X 10(6) as determined by electron microscopy. A number of phages propagated on Mycobacterium smegmatis ATCC 607 were tested for their ability to infect strain LR25. Phage JF2 gave an efficiency of plating of 10(-4) on strain LR25, but phage JF2 propagated on strain LR25 infected strain LR25 and M. smegmatis with equal high efficiency. This indicated the presence of a restriction-modification (R-M) system in strain LR25 that was not present in M. smegmatis. Strain LR25 was grown in the presence of acriflavine to eliminate the plasmids and tested for sensitivity to phage JF2. One of forty colonies was found to be R-M-deficient. This strain, designated strain LR163, lacks the three plasmids present in strain LR25. The results indicate that the R-M system is plasmid-coded. Strain LR163 was sensitive to several phages to which strain LR25 was resistant and for which we were unable to isolate modified phage. This suggests that some plasmid-coded function in addition to restriction is involved. An R-M system was also demonstrated in M. avium intracellulare strain LR131 using phage JF1. This strain does not carry plasmids.

Fourth Report of the Cooperative, Open-Ended Study of Slowly Growing Mycobacteria by the International Working Group on Mycobacterial Taxonomy

The open-ended study of the International Working Group on Mycobacterial Taxonomy is an ongoing project to characterize slowly growing strains of mycobacteria that do not belong to well-established or thoroughly characterized species. In this fourth report we describe two numerical taxonomic clusters that represent subspecies or biovars of Mycobacterium simiae, one cluster that encompasses the erstwhile type strain of the presently invalid species "Mycobacterium paraffinicum," one cluster that is phenotypically very similar to Mycobacterium avium and Mycobacterium intracellulare but may be a separate genospecies, one cluster that appears to be phenotypically distinct from M. avium but reacts with a nucleic acid probe specific for M. avium, and three tentatively defined clusters in proximity to a cluster that encompasses the type strain of Mycobacterium malmoense. Of special practical interest is the fact that one of the latter three clusters is composed of clinically significant scotochromogenic bacteria that can be misidentified as the nonpathogenic organism Mycobacterium gordonae if insufficient biochemical tests are performed.

Comparison of the seroagglutination test with the pathogenicity test in the chicken for the identification of Mycobacterium avium and Mycobacterium intracellulare.

The seroagglutination test for the identification of Mycobacterium avium and Mycobacterium intracellulare and the pathogenicity test for M. avium by intraperitoneal inoculation of chickens were compared using 188 strains of the M. avium and M. intracellulare group isolated from birds, cattle, swine, and other animals. Twenty of 21 strains isolated from tuberculous birds were of the two serotypes of M. avium and were pathogenic. All but 3 of 138 strains of the M. avium serotypes isolated from other animal species also were pathogenic. Ten of 30 strains of M. intracellulare serotypes also were pathogenic.