A 48-year-old HIV-positive male presents with 3 weeks of cough, fever, night sweats, weight loss and diarrhea. He is not taking any treatment for HIV and has a CD4 count of <50. Most likely diagnosis is -
The above clinical presentation is suggestive of MAC infection Mycobacterium avium complex in HIV patients - Mycobacterium aviumcomplex consists of multiple nontuberculosis mycobacterial species (NTM) It is the most common cause of nontuberculosis mycobacterial species infections in humans Respiratory system is the most common site of infection It is a nonmotile, non-spore-forming, gram-positive acid-fast bacillus. Itis a nonchromogen and slow-growing and takes about 10 to 20 days to develop mature colonies MAC isacquired by inhalation and can also be ingested into the gastrointestinal tract, where it adheres to the mucosal epithelial cells and infects the macrophages. Risk factors forMycobacterium avium complex pulmonary disease are - CD4 count less than 50 in AIDS patients Low CD4 in lymphoreticular malignancies Pneumoconiosis, Chronic obstructive pulmonary disease (COPD) Cystic fibrosis Other chronic lung diseases Persons with thoracic and skeletal abnormalities such as severe scoliosis, straight back syndrome, Patients with mitral valve prolapse, Immunosuppression post-transplant Patients with deficiency in IFN-gamma production as well as IFN-gamma receptor deficiency. Clinical features - Mycobacterium aviumcomplex infections occur when the CD4 counts are less than 50. Mycobacterium avium complex infections frequently present as disseminated infections. However M. intracellulare does not cause disseminated disease in HIV patients. Common clinical findings are Fever (MC), night sweats , weight loss , abdomen pain, diarrhea, mesenteric lymphadenopathy, anemia, elevated alkaline phosphatase, and elevated lactate dehydrogenase Treatment - The medications used in the treatment of Mycobacterium avium complex infections are a macrolides, clofazimine, rifampin, rifabutin, ethambutol, fluoroquinolone, linezolid, and aminoglycosides Preferred regimens must contain clarithromycin and ethambutol.
Cytomegalovirus
Mycobacterium avium complex
Candidiasis
Pneumocystis jiroveci
Tuberculosis