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This Article Full Text (PDF) All Versions of this Article: chest.07-2171v1 133/4/875    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cattamanchi, A Articles by Daley, C. Search for Related Content PubMed PubMed Citation Articles by Cattamanchi, A Articles by Daley, C.

Detailed analysis of the radiographic presentation of Mycobacterium kansasii lung disease in HIV-infected patients

¹University of California, San Francisco ²University of Toronto ³University of Pittsburgh ⁴National Jewish Medical and Research Center

acattamanchi{at}medsfgh.ucsf.edu

Abstract

BackgroundPublished criteria for the diagnosis of Mycobacterium kansasii lung disease require the presence of clinical symptoms, positive microbiologic studies, and radiographic abnormalities. In human immunodeficiency virus (HIV) -infected patients, the radiographic findings of M. kansasii lung disease are not well described.

MethodsMedical records and chest radiographs of all HIV-infected patients with at least one respiratory specimen culture positive for M. kansasii at San Francisco General Hospital between December 1989 and July 2002 were reviewed.

ResultsChest radiographs were abnormal in 75/83 (90%) patients included in the study. Radiographic abnormalities were diverse with consolidation (66%) and nodules (42%) as the most frequent finding. The mid or lower lung zones were involved in 89% of patients. The pattern of radiographic abnormalities did not differ based on acid fast bacillus smear status, the presence or absence of co-existing pulmonary infections, or CD4+ T-lymphocyte count. In multivariate Cox regression analysis, cavitation was the only radiographic abnormality independently associated with mortality (HR 4.8, 95% CI 1.2-19.6).

ConclusionHIV-infected patients with M. kansasii lung disease present with diverse radiographic patterns, most commonly consolidation and nodules predominantly located in the mid and lower lung zones. This finding is in contrast to the upper lobe cavitary presentation described in HIV-uninfected patients. Though rare, the presence of cavitary disease in HIV-infected patients with M. kansasii independently predicts worse outcome. The diversity in the radiographic presentation of M. kansasii lung disease implies that clinicians should obtain sputum mycobacterial cultures from any HIV-infected patient with an abnormal chest radiograph.

Key Words: Mycobacterium kansasii, Mycobacteria • Atypical • Radiography • HIV