Early Manifestations of Disseminated Mycobacterium avium Complex Disease: A Prospective Evaluation

A nested case-control study was conducted in two trials of prophylaxis for Mycobacterium avium complex (MAC) infection to describe the specific signs, symptoms, and laboratory abnormalities of MAC disease in AIDS. Patients had ⩽200/mm3 CD4 cells and a prior AIDS-defining illness. Of 571 patients, 10...

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Bibliographic Details
Published in:The Journal of infectious diseases 1997-07, Vol.176 (1), p.126-132
Main Authors: Gordin, Fred M., Cohn, David L., Sullam, Paul M., Schoenfelder, John R., Wynne, Beverley A., Horsburgh, C. Robert
Format: Article
Language:English
Subjects:
Adult
AIDS
AIDS/HIV
Bacteremia
Bacteremia - etiology
Bacterial diseases
Biological and medical sciences
Blood
Double-Blind Method
Epidemiology
Female
Fungal diseases
Fungal infections
Human bacterial diseases
Humans
Infections
Infectious diseases
Major Articles
Male
Medical sciences
Middle Aged
Mycobacterium avium complex
Mycobacterium avium-intracellulare Infection - complications
Mycobacterium avium-intracellulare Infection - mortality
Prospective Studies
Survival Rate
Symptoms
Tuberculosis and atypical mycobacterial infections
Weight Loss
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Summary:A nested case-control study was conducted in two trials of prophylaxis for Mycobacterium avium complex (MAC) infection to describe the specific signs, symptoms, and laboratory abnormalities of MAC disease in AIDS. Patients had ⩽200/mm3 CD4 cells and a prior AIDS-defining illness. Of 571 patients, 102 (17.9%) developed MAC bacteremia during a mean follow-up of 256 days. Among cases of MAC disease, 90 were compared with 180 matched controls. Patients with MAC disease were more likely than controls to have lower weights (66.3 vs. 71.1 kg, P = .001) and Karnofsky scores (74.3 vs. 84.4, P < .001); a higher proportion had fever (48% vs. 26%, P = .003), abdominal pain (23% vs. 13%, P = .05), decreased hemoglobin levels (10.9 vs. 12.1 g/dL, P < .001), and elevated alkaline phosphatase (203 vs. 138 U/L, P = .04) and lactate dehydrogenase (334 vs. 280 U/L, P = .02) levels. Characteristics of MAC disease that occurred before bacteremia were weight loss (3 months prior), fever (2 months), and anemia and elevated lactate dehydrogenase (1 month). These data suggest that patients have symptomatic MAC disease for several months prior to the occurrence of bacteremia.
ISSN:0022-1899
1537-6613
DOI:10.1086/514014