Clinical Significance and Epidemiologic Analyses of Mycobacterium avium and Mycobacterium intracellulare among Patients without AIDS

Author:

Han Xiang Y.1,Tarrand Jeffrey J.1,Infante Rosa2,Jacobson Kalen L.2,Truong Mylene3

Affiliation:

1. Sections of Clinical Microbiology

2. Infectious Diseases

3. Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, Texas

Abstract

ABSTRACT The clinical significance and prevalence of Mycobacterium avium and Mycobacterium intracellulare were analyzed in a cohort of 7,472 patients who, from 1999 to 2003, sought care at the University of Texas M.D. Anderson Cancer Center, Houston, and had cultures performed for mycobacteria. Patients were stratified for age, sex, and underlying diseases, and bacteria were identified by 16S rRNA gene sequencing. M. avium was isolated in 62 (0.83%) of 7,472 patients and M. intracellulare in 65 (0.87%). Clinically, only 10 of the 62 (16.2%) patients with M. avium had probable to definite evidence of infection, whereas the majority (83.8%) had weak evidence of infection. Sex and age did not affect the isolation or infection of M. avium . Hematological tumors predisposed to M. avium colonization but not infection. In contrast, 41 of the 65 (63.1%) patients with M. intracellulare had probable to definite infection, a level much higher than those with M. avium ( P < 0.001). M. intracellulare was more prevalent in women (1.33% of 3,311) than in men (0.50% of 4,161) ( P < 0.001), and underlying diseases had no effect in women. Men with lung cancer had a higher prevalence (1.37%) than men without (0.34%) (4.0-fold; P < 0.001), but it was similar to that in women. A marked age trend for the isolation of M. intracellulare among women was noted: 0.27% (1-fold) for ages of <50 years, 0.85% (3.1-fold) for ages 50 to 59 years, 1.50% (5.6-fold) for ages 60 to 69 years, and 3.74% (13.9-fold) for ages ≥70 years (trend, P < 0.001). The combined rate for women ≥50 was 1.86% (95% confidence interval [1.30 to 2.42%]) (6.9-fold). Together, these results suggest that, among non-AIDS patients, M. intracellulare is more pathogenic and tends to infect women increasingly beyond menopause (age ≥50 years) regardless of underlying disease. The prevalence rate of 1.86% in postmenopausal women suggests the need to further investigate the public health significance of M. intracellulare .

Publisher

American Society for Microbiology

Subject

Microbiology (medical)

Reference24 articles.

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2. American Thoracic Society. 1997. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am. Rev. Respir. Dis.156:S1-S25.

3. Centers for Disease Control and Prevention. 1999. Nontuberculous mycobacteria reported to the public health information system by the state public health laboratories United States 1993-1996. [Online.] www.cdc.gov/ncidod/dastlr/mycobacteriology.htm .

4. Factors Influencing Numbers of Mycobacterium avium , Mycobacterium intracellulare , and Other Mycobacteria in Drinking Water Distribution Systems

5. Good, R. C., and D. E. Snider. 1982. Isolation of nontuberculous mycobacteria in the United States, 1980. J. Infect. Dis.146:829-833.

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