Chest
Volume 93, Issue 5, May 1988, Pages 926-932
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Clinical Investigations
Mycobacterium avium Complex Infection in Patients with the Acquired Immunodeficiency Syndrome: A Clinicopathologic Study

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Despite the recognition of Mycobacterium avium complex (MAC) infection as a common complication of AIDS, the specific clinical features, significance, and need for treatment have been difficult to assess. We reviewed the clinical records and autopsy material of 68 patients dying with AIDS, 32 (47 percent) of whom had MAC isolated from autopsy tissue. All had postmortem evidence of systemic infection. Eleven (34 percent) had MAC isolated from lung tissue. Little, if any, local tissue inflammation and destruction were associated with MAC infection. Patients with autopsy evidence of MAC infection had a longer time interval from diagnosis of AIDS to death. The infection was detected antemortem in 14 (44 percent), blood culture being the most sensitive means (86 percent yield). Although recurrent fever was noted among both MAC infected and uninfected patients, weight loss greater than 20 lb, weakness, anorexia, abdominal pain, and diarrhea were more frequent among infected patients. Severe anemia, thrombocytopenia, lymphopenia, and reduced mean CD-4 percentages and CD-4/CD-8 ratios were associated with MAC infection. Of eight patients who had MAC cultured antemortem and received multidrug antituberculosis therapy, none responded clinically, and all but one had MAC isolated at autopsy. Because MAC is associated with significant discomfort and disability, development of more effective treatment regimens could be beneficial for some affected AIDS patients.

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MATERIAL AND METHODS

The autopsy records of all patients reported in the UCLA Medical Center Autopsy Registry to have died with AIDS between November 1981 and January 1986 were reviewed. Of the patients thus identified, 68 fulfilled the criteria for the diagnosis of AIDS established by the Centers for Disease Control10 and were included in the study. The abnormal gross findings and the pathologists formulation of the cause of death were recorded.

For each case, sections of lung, lymph nodes, spleen, adrenal, and

Autopsy Findings

In 24 of the 32 patients with MAC isolated at autopsy, the organism was also demonstrated by microscopic examination of autopsy tissue. In the remaining eight, MAC was detected by culture only. The organism was isolated from the spleen in all cases, and in nine, the spleen was the only culture-positive organ. MAC was isolated from lung tissue in 11 patients. Table 1 shows the sites of microscopically demonstrated involvement. Acid-fast bacilli were observed in one site in five patients (16

DISCUSSION

Despite the high frequency of MAC infection in patients with AIDS, the specific clinical features and contribution to morbidity and mortality have been difficult to define.6,14 In an effort to elucidate these issues, we correlated the autopsy findings and antemortem clinical data from a postmortem population of AIDS patients. The clinicopathologic data obtained suggest that there are specific predisposing factors and clinical characteristics associated with MAC infection.

Although a variety of

ACKNOWLEDGMENTS

The authors thank Dr. I. Jeffry Strumpf for his help in obtaining clinical information on the patients treated in the Southern California Kaiser Permanente system.

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Presented in part at the Annual Meeting, American Thoracic Society, May 12, 1985, Anaheim, Calif.

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