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an epidemiologic analysis of mycobacterium avium complex disease in homosexual men infected with human immunodeficiency virus type 1.cofactors associated with the mycobacterium avium complex (mac) disease and its prognosis in incident cases of aids in homosexuals were studied. we compared 51 men in whom mac disease developed as the initial aids-defining illness (termed aids illness hereafter); 157 men who had mac disease subsequent to another aids illness; and 884 men who had only non-mac aids illnesses. mac disease was the initially diagnosed aids illness more often in baltimore (6.9%) and los angeles (5.6%) than in chicago ...19957620006
pentoxifylline impairs macrophage defense against mycobacterium avium complex.pentoxifylline, a tumor necrosis factor-alpha (tnf) inhibitor, is being tested as a treatment adjunct in human immunodeficiency virus (hiv)-infected patients. however, tnf is important in cellular defense. the effect of pentoxifylline on mycobacterium avium complex (mac) growth in exogenously infected macrophages was compared with the effect of dexamethasone. pentoxifylline, in a concentration that decreased mac-induced tnf by 48.1%, enhanced mac growth by 1.9- to 19.6-fold and 1.82- to 4.46-fol ...19957658084
enhancement of antibiotic susceptibility and suppression of mycobacterium avium complex growth by poloxamer 331.the resistance of mycobacterium avium complex (mac) to antibiotics is thought to be enhanced by its outer glycolipid layer, which protects the organisms from antibiotics and host defense mechanisms. we hypothesized that surfactants which disrupt the lipid barrier might be of therapeutic value. we evaluated the ability of 10 poloxamer surfactants to inhibit the growth of mac organisms and to potentiate antimycobacterial drug activity in broth culture using a radiometric assay. very large, small, ...19957726511
dapsone/pyrimethamine may prevent mycobacterial disease in immunosuppressed patients infected with the human immunodeficiency virus.dapsone exhibits activity against mycobacterium tuberculosis and mycobacterium avium complex (mac) in vitro. we retrospectively examined the incidence of mycobacterial diseases within a randomized prospective trial of prophylaxis for pneumocystis carinii pneumonia and toxoplasmosis. of 501 participants who had not previously had a mycobacterial disease, 274 received dapsone/pyrimethamine (200/75 mg once weekly) and 227 received aerosolized pentamidine (300 mg once every 4 weeks). the median cd4 ...19957742423
comparison of multiple drug therapy regimens for hiv-related disseminated mycobacterium avium complex disease.in june 1993, the united states public health service (usphs) made recommendations for treatment of disseminated mycobacterium avium complex (mac) in patients infected with the human immunodeficiency syndrome (hiv). it was suggested that every treatment regimen include either azithromycin or clarithromycin plus one or more of the following drugs: ethambutol, clofazimine, rifabutin, rifampin, ciprofloxacin, or amikacin. this study compares the effect of multiple drug therapy regimens on the survi ...19957749789
mycobacterium avium complex in water, food, and soil samples collected from the environment of hiv-infected individuals.as part of an epidemiologic study of mycobacterium avium complex (mac) infection in san francisco, water, food and soil samples were collected from the home environment of 290 persons with human immunodeficiency virus (hiv) infection and cultured for mycobacteria. isolates recovered from the environment were compared with isolates cultured from study patients. although mycobacteria were recovered from numerous environmental samples, isolates reactive with mac-specific dna probes were recovered f ...19957749796
mycobacterium avium: a potentially treatable cause of pericardial effusions.we present a patient with a very large pericardial effusion due to disseminated mycobacterium avium complex (mac) infection with associated bacteraemia and gastroenteritis. he was hiv antibody-positive with a cd4+ lymphocyte count of 10 x 10(6)/l. he complained of fevers, diarrhoea and dyspnoea and an echocardiogram showed a pericardial effusion. chest x-ray showed progressive enlargement of the cardiac silhouette over a 3-month period. the effusion was drained surgically and antimycobacterial t ...19957751668
mycobacterium avium complex (mac) osteomyelitis and septic arthritis in an immunocompetent host.we describe a case of mycobacterium avium complex (mac) osteomyelitis and septic arthritis in an immunocompetent man. infection was derived from a chainsaw injury sustained on the lateral aspect of the ankle 13 years earlier, and had spread through the bone, joint and soft tissue emerging at the medial aspect. this was successfully treated with surgical debridement, drainage, arthrodesis and 18 months of chemotherapy consisting of clarithromycin, rifampicin, ethambutol, and ciprofloxacin with an ...19957751669
long-term safety of ofloxacin and ciprofloxacin in the treatment of mycobacterial infections.ofloxacin and ciprofloxacin are potentially useful agents for treating mycobacterial infections. we retrospectively reviewed 7 years' experience with these agents in 103 patients. ofloxacin was used primarily to treat tuberculosis (tb), dosed to achieve 2-hour postdose serum concentrations of 8-12 micrograms/ml. ciprofloxacin was used primarily to treat mycobacterium avium complex (mac) infection, dosed to achieve 2-hour post-dose serum concentrations of 4-6 micrograms/ml. despite differences in ...19957767552
intracellular activities of roxithromycin used alone and in association with other drugs against mycobacterium avium complex in human macrophages.recent reports have shown that roxithromycin possesses significant activity against atypical mycobacteria, including the mycobacterium avium complex (mac), and that its extracellular anti-mac activity is further enhanced in two- or three-drug combinations with ethambutol, rifampin, amikacin, ofloxacin, and clofazimine. in accordance with the above data, the anti-mac potential of roxithromycin used alone and in combination with the above-mentioned antituberculous drugs was screened intracellularl ...19957786006
ct features of pulmonary mycobacterium avium complex infection.the purposes of this study were to describe and compare the prevalence of disease features in subjects with mycobacterium avium complex (mac) disease with those of mycobacterium tuberculosis infection (mtb), to compare the abilities of ct and chest radiography to identify the features of mac disease, and to determine if sputum positivity is related to any of the ct features of mac disease.19957790541
in vitro and ex vivo activities of antimicrobial agents used in combination with clarithromycin, with or without amikacin, against mycobacterium avium.mics of clarithromycin, amikacin, isoniazid, rifabutin, ciprofloxacin, sparfloxacin, ethambutol, and clofazimine were determined for six isolates of mycobacterium avium complex (mac) from aids patients both by the radiometric method and by an ex vivo model of infection in human macrophages. the median mics in macrophages were similar or slightly lower than values found in broth, except for amikacin, which had slightly higher mics inside the cells. combinations of clarithromycin with other antimi ...19957793873
therapy of mycobacterium avium complex infections in beige mice with streptomycin encapsulated in sterically stabilized liposomes.mycobacterium avium complex (mac) causes serious opportunistic infections in aids patients. previous studies with mac-infected beige mice have indicated that weekly administration of liposome-encapsulated streptomycin can reduce significantly the cfu in the liver and spleen. we examined whether streptomycin encapsulated in recently developed sterically stabilized liposomes with prolonged circulation times would have a therapeutic effect in this animal model. two liposome types with prolonged cir ...19957793880
response to stimulation with recombinant cytokines and synthesis of cytokines by murine intestinal macrophages infected with the mycobacterium avium complex.current evidence suggests that the gut is the chief portal of entry for organisms of the mycobacterium avium complex (mac) in aids patients. bacterial invasion of intestinal mucosa presumably occurs through epithelial cells, and m cells in the peyer's patches, where the bacteria have contact with immunocompetent cells such as macrophages and t and b lymphocytes. as mucosal macrophages are probably the first line of defense against mac, we examined their ability to inhibit intracellular growth of ...19957822018
disseminated mycobacterium avium infection among hiv-infected patients in kenya.previous studies from africa have been unable to identify disseminated mycobacterium avium complex (mac) infection in patients with advanced human immunodeficiency virus (hiv) infection. we performed mycobacterial blood cultures and cd4 counts on 48 symptomatic adults with advanced hiv infection admitted to the hospital in nairobi, kenya over 4 weeks in 1992. fourteen patients had mycobacteremia; these patients had significantly lower cd4 counts than the patients with negative cultures (14/mm3 v ...19957834402
mycobacterium avium complex (mac): an unusual potential pathogen in cerebrospinal fluid of aids patients.mycobacterium avium complex (mac) is frequently isolated from patients with late complications of acquired immunodeficiency syndrome (aids), especially in north america and europe. however, its isolation from the central nervous system (cns) has been seldom reported in these countries. mac infections in aids patients in african and latin american countries are believed to be uncommon. we report the isolation of mac from cerebrospinal fluid (csf) of 11 aids patients out of 1723 (0.63%) seen at "c ...19957481477
the role of tumor necrosis factor, interferon-gamma, transforming growth factor-beta, and nitric oxide in the expression of immunosuppressive functions of splenic macrophages induced by mycobacterium avium complex infection.in order to verify the participation of some cytokines in the expression of the suppressor activity of splenic macrophages (m phi s) induced by mycobacterium avium complex (mac) infection, we studied whether anticytokine antibodies were capable of blocking their suppressor activity against concanavalin a (cona)-induced mitogenesis of splenocytes (spcs). when either anti-tumor necrosis factor (tnf), anti-transforming growth factor-beta (tgf-beta), or anti-interferon-gamma (ifn-gamma) antibody was ...19957499969
rifabutin-associated uveitis.to review rifabutin-associated uveitis and discuss the mechanism and potential role of drug interactions with clarithromycin and fluconazole in contributing to this adverse event.19958573961
altered in vitro handling of mycobacterium avium complex by monocytes and serum from hiv(+) patients.in patients with acquired immunodeficiency syndrome (aids), mycobacterial diseases are leading opportunistic infections. the reasons for the peculiar propensity for disseminated infection with mycobacterium avium complex (mac) remain unclear. we have previously examined, in detail, the ability of monocytes from healthy donors to take up and kill mac under both nonopsonic and opsonic conditions. we have now evaluated the in vitro ability of peripheral blood monocytes from hiv(+) patients to take ...19958575843
the endoscopic appearance of severe intestinal mycobacterium avium complex infection as a coarsely granular mucosa due to massive infiltration and expansion of intestinal villi without mucosal exudation.although mycobacterium avium complex (mac) is the most common opportunistic pathogen at postmortem in patients with aids, many cases are not recognized premortem. a patient with advanced aids had diarrhea, fecal occult blood, and iron deficiency anemia. esophagogastroduodenoscopy showed an extensive coarsely granular mucosa, resistant to endoscopic irrigation and brushing, in the descending duodenum. histologic analysis of duodenal biopsies confirmed expansion of intestinal villi due to massive ...19958583111
efficacy of azithromycin and rifabutin in preventing infection by mycobacterium avium complex in beige mice.we investigated the potential of the azalide, azithromycin, and rifabutin in preventing disseminated infection due to mycobacterium avium complex (mac) in beige mice. azithromycin 200 mg/kg, rifabutin (30 mg/kg or 60 mg/kg) were administered by gavage 6 days before mice were challenged orally with 10(8) cfu mac and daily for 10 days thereafter during which time the mice were again challenged with the same inoculum on alternate days (days +1, +3, +5, +7, and +9). sixty-four days later, the presen ...19958591938
antimycobacterial activity of a new rifamycin derivative, 3-(4-cinnamylpiperazinyl iminomethyl) rifamycin sv (t9).the antimycobacterial activities of a new rifampin (rif) derivative, 3-(4-cinnamylpiperazinyl iminomethyl) rifamycin sv (to), against 20 susceptible and multidrug-resistant strains of mycobacterium tuberculosis and 20 mycobacterium avium complex (mac) strains were investigated. the radiometric mics of t9 for m. tuberculosis were significantly lower than those of rif. the mics of t9 and rif at which 90% of the rif-susceptible strains were inhibited were < or = 0.25 and < or = 0.5 micrograms/ml, r ...19958619589
mycobacterium avium complex infection in aids: clinical features, treatment, and prevention.infection with mycobacterium avium complex (mac) may cause a serious disseminated bacterial infection in up to 40% of patients with advanced hiv infection. disseminated mac has a negative impact on quality of life and contributes significantly to morbidity and mortality. prompt diagnosis and aggressive treatment can diminish those effects. disseminated disease can be prevented in many patients with the use of rifabutin prophylaxis. nurses play an important role in evaluating symptoms and educati ...19958785415
[value of the stool bacteriological test in mycobacterium avium complex infections in aids].incidence of mycobacterium avium complex (mac) infection has increased in hiv infected patients. we report a retrospective study of 25 cases of mac infection occurring in hiv patients. stools examination was performed in 5 (31%) of the patients without digestive symptoms and in the 9 (100%) patients presenting with diarrhoea. the stools culture are positive in 79% of cases (11/14). in all the patients with diarrhoea, direct examination of the stools gave the diagnosis of mac infection. all the p ...19958787291
frequencies of opportunistic diseases prior to death among hiv-infected persons. community programs for clinical research on aids.to describe the complete history of major opportunistic events experienced by 1883 hiv-infected persons prior to and specifically within 6 months of death, and to determine whether the frequency of specific events varies according to demographic characteristics, risk behaviors or geographic location.19958519450
isolation of atypical mycobacteria from tap water in hospitals and homes: is this a possible source of disseminated mac infection in aids patients?infections caused by mycobacteria other than tuberculosis (mott), especially mycobacterium avium complex (mac), are common in aids patients, but rare in immunocompetent persons. the route of transmission is unknown, but tap water could provide a possible source of infection: mac was isolated from tap water in the u.s.a. but this has not been reported in germany. we therefore investigated tap water in berlin for the presence of mycobacteria and compared radiometric (bactec) and standard plate cul ...19958522830
adverse events associated with high-dose rifabutin in macrolide-containing regimens for the treatment of mycobacterium avium complex lung disease.we initiated a multidrug trial that included high-dose rifabutin for the treatment of pulmonary mycobacterium avium complex (mac) disease. twenty-six patients received rifabutin (600 mg/d) in combination with ethambutol, streptomycin, and either clarithromycin (500 mg b.i.d.; 15 patients) or azithromycin (600 mg/d; 11 patients). rifabutin-related adverse events occurred in 77% of patients. fifty-eight percent of patients required a dosage adjustment or discontinuance of rifabutin therapy. the mo ...19958527549
acquired resistance in mycobacterium avium complex strains isolated from aids patients and beige mice during treatment with clarithromycin.clarithromycin has been reported to select clarithromycin resistant mutants of mycobacterium avium complex (mac) during treatment with clarithromycin in aids patients and beige mice. we selected resistant mutants in vitro at a frequency of 5 x 10(-9). clarithromycin resistant strains of mac isolated in aids patients and beige mice as well as derivatives selected in vitro had a unique pattern of acquired cross-resistance to macrolides and related antibiotics. in contrast, the pattern of resistanc ...19958537260
disseminated mycobacterium avium complex infection in aids: immunopathogenic significance of an activated tumor necrosis factor system and depressed serum levels of 1,25 dihydroxyvitamin d.disseminated mycobacterium avium complex (mac) infection is associated with considerable morbidity and mortality in patients with aids. because both tumor necrosis factor-alpha (tnf-alpha) and 1,25-dihydroxyvitamin d3 (1,25d) may be involved in the normal control of mac infection, these parameters were studied in aids patients with disseminated mac infection. of 53 aids patients studied, 24 had no clinical events, 11 had disseminated mac infection, and 18 had other clinical events. patients with ...19968537672
mycobacterium avium complex sputum isolates from patients with respiratory symptoms in guinea-bissau.in total, 814 patients with clinically suspected tuberculosis were examined at the raoul follerau hospital in bissau, guinea-bissau. sputum samples were collected, and cultures were grown on löwenstein-jensen medium. isolates were further characterized by standard biochemical methods and nucleic acid probes for mycobacterium tuberculosis and mycobacterium avium complex (mac). serum samples were collected and analyzed for antibodies against human immunodeficiency virus (hiv) types 1 and 2. of 17 ...19968537673
impact of mycobacterium avium complex prophylaxis on the incidence of mycobacterial infections and transfusion-requiring anemia in an hiv-positive population.disseminated mycobacterium avium complex (mac) infection is common in persons with advanced hiv infection and can be prevented by prophylactic use of rifabutin; however, routine prophylaxis is costly and incompletely effective. chronic anemia is a common manifestation of mac infection. we conducted a retrospective population study of the annual incidence of mac bacteremia and blood transfusion for anemia in a regional hiv-positive population before and after the introduction of rifabutin to dete ...19968797683
disseminated mycobacterium avium complex. review of ga-67 and ti-201 scans and autopsy findings.a retrospective analysis of the files and ga-67 scan findings of 32 aids patients with established diagnosis of disseminated mycobacterium avium complex (mac) was conducted in order to determine the sensitivity of ga-67 scans for the diagnosis of this disease and the sites of mac organ involvement. fourteen of the 32 patients had early and delayed ti-201 scans that were also reviewed. autopsy findings of aids patients in the 5 years (january 1990 to december 1994) were reviewed to determine the ...19968818469
therapeutic options for the management and prevention of mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome.atypical mycobacteria that cause disseminated disease result in significant morbidity and mortality among patients with advanced human immunodeficiency viral infection. although significant progress has been made with respect to our understanding of the epidemiology, microbiology, and pathogenesis of mycobacterium avium complex (mac) infections in patients with the acquired immunodeficiency syndrome (aids), treatment and prevention strategies are still emerging. a series of case-controlled studi ...19968820462
nontuberculous mycobacterial infections.to review the epidemiology, clinical manifestations, diagnosis, and treatment of nontuberculous mycobacterial infections other than mycobacterium avium complex (mac).19968826567
how effective is krm-1648 in treatment of disseminated mycobacterium avium complex infections in beige mice?although the mics of 3'-hydroxy-5'-(4-isobutyl-1-piperazinyl)benzoxazinorifamycin, or krm-1648 (krm), for mycobacterium avium complex (mac) were significantly lower than those of other drugs, its in vivo activity was very weak. beginning 28 days after inoculation, beige mice that had been infected intravenously with 1.87 x 10(7) cfu of mac 101 were administered krm alone, clarithromycin (clari) alone, or clari plus krm six times weekly for 16 weeks. in contrast to the mice treated with clari-con ...19968834894
causes of fever in patients infected with human immunodeficiency virus who were admitted to boston city hospital.we prospectively studied causes of fever in patients with human immunodeficiency virus (hiv) infection that required admission to a municipal hospital. a total of 168 hiv-infected persons were admitted for 220 episodes of fever: 72% were male, 80% were nonwhite, 65% reported prior injection drug use, and 74% had a baseline cd4 lymphocyte count of < 200/mm3. bacterial infections, principally pneumonia, accounted for > 60% of the episodes; streptococcus pneumoniae and staphylococcus aureus were mo ...19968842271
induction of prostaglandin e2 by human monocytes infected with mycobacterium avium complex--modulation of cytokine expression.prostanoids, including prostaglandin e2 (pge2), suppress macrophage effector functions against mycobacterium tuberculosis. pge2 production by monocytes infected with mycobacterium avium complex (mac) and its effects on intracellular mycobacterial growth were examined. freshly obtained monocytes from healthy subjects were stimulated with lipopolysaccharide or 10(7) organisms/ml of 4 mac strains. pge2 production in monocyte supernatants peaked at 48 h. significantly higher levels of pge2 were prod ...19968843220
pathobiological significance of colony morphology in mycobacterium avium complex.mycobacterium avium complex (mac) strains are known to exhibit variation in colony morphology. in addition to the smooth transparent (st), smooth opaque (so) and rough opaque (ro), which are the most common morphological forms, intermediate (im) and pin point (pp) forms were also occasionally observed. in order to understand the pathobiological significance of these different colony forms, we investigated their virulence in beige mice, ability to bind to plastic and epithelial cells, differences ...19968844653
fatal mycobacterium avium complex disease in a patient with acute nonlymphoblastic leukemia.the objective of this article was to present the diagnosis of a fatal infection by mycobacterium avium complex (mac) in a child with acute myelogenous leukemia, a disease rarely reported in non-hiv infected children.19968846144
activities of bay y 3118, levofloxacin, and ofloxacin alone or in combination with ethambutol against mycobacterium avium complex in vitro, in human macrophages, and in beige mice.levofloxacin, ofloxacin, and bay y 3118 are new fluoroquinolones with variable in vitro bacteriostatic and bactericidal activities against the mycobacterium avium complex (mac). the potential therapeutic activities of these agents both alone and combined with ethambutol were evaluated in a human macrophage test system and in the beige mouse animal test system with mac strain 101. bay y 3118 at a human-equivalent dose of 30 mg/kg/day for 4 weeks caused a significant reduction in mortality compare ...19968851568
in vitro activities of rifabutin, azithromycin, ciprofloxacin, clarithromycin, clofazimine, ethambutol, and amikacin in combinations of two, three, and four drugs against mycobacterium avium.multidrug therapy is recommended for treatment of mycobacterium avium complex (mac) bacteremia in patients with aids. azithromycin, clarithromycin, rifabutin, ciprofloxacin, ethambutol, clofazimine, and amikacin have all been suggested for use in treating mac bacteremia, but the most active combinations of these drugs have not been identified, nor has the minimum number of drugs needed for effective therapy been determined. to address the former, the in vitro bactericidal activities of all two-, ...19968851604
skin testing with mycobacterium avium sensitin to identify infection with m. avium complex in patients with cystic fibrosis.we sought to determine if patients with cystic fibrosis and sputum cultures positive for mycobacterium avium complex (mac) have delayed-type hypersensitivity to an m. avium sensitin. seventeen (33%) of 51 selected patients had mac isolated from at least one sputum culture. skin tests with purified protein derivative and m. avium sensitin demonstrated that five (10%) of 51 patients were anergic, and anergy was correlated with use of systemic steroids. sixteen (35%) of 46 nonanergic patients had m ...19968852979
the international epidemiology of disseminated mycobacterium avium complex infection in aids. international mac study group.to determine rates of disseminated mycobacterium avium complex (mac) infection among aids patients in developed and developing countries, and to determine whether different rates reflect differences in exposure or immunity, or both.19968853737
comparison of mycobacteria growth indicator tube with bactec 460 for detection and recovery of mycobacteria from clinical specimens.we compared the mycobacteria growth indicator tube (mgit) system with the bactec 460 (b460) and lowenstein jensen (lj) systems for the recovery of mycobacteria (acid-fast bacteria [afb]) from 1,441 clinical specimens. excluding 13 isolates of mycobacterium gordonae, 178 significant afb isolates were recovered from 113 patients. isolates (119) of the mycobacterium avium complex (mac) accounted for 67% of all isolates, while isolates (30) of the mycobacterium tuberculosis complex (mtb) accounted f ...19968862591
macrophage release of tumor necrosis factor-alpha by mycobacterium avium antigens.mycobacterium avium complex (mac) infection is the most common disseminated opportunistic infection encountered in patients with aids. we have studied the ability of specific mycobacterium avium (ma) antigen to stimulate human monocyte-derived macrophages (mdm) to produce tumor necrosis factor-alpha (tnf-alpha). mdm stimulated with ma sonicate, ma 68 kda and ma 48-52 kda antigens were found to produce tnf-alpha in a dose-dependent manner. reverse transcriptase-polymerase chain reaction analysis ...19968871113
pharmacokinetic evaluation of thiacetazone.to investigate the steady-state pharmacokinetics of thiacetazone (tb-1), which is active in vitro against mycobacterium avium complex (mac).19968888068
new trends in the drug therapy of localized and disseminated mycobacterium avium complex infection.recent advances in the drug therapy of localized and disseminated infection with mycobacterium avium complex (mac) are reviewed. mac infection is the most commonly reported bacterial infection in patients with aids, and the frequency of this infection in patients negative for the human immunodeficiency virus (hiv) is increasing. the main portals of entry for mac are the gastrointestinal and respiratory tracts. localized mac infection is more common in hiv-negative than hiv-infected patients. the ...19968913387
enhanced in vitro activity of wr99210 in combination with dapsone against mycobacterium avium complex.wr99210, a dihydrofolate reductase inhibitor, has promising in vitro activity against mycobacterium avium complex (mac). the in vitro activities of wr99210 alone and in combination with a fixed concentration of dapsone (0.5 microgram/ml) were evaluated against 35 clinical mac isolates by a broth dilution method. the mic at which 50% of isolates were inhibited (mic50) and mic90 of wr99210 alone were 2 and 8 micrograms/ml, respectively. the mic50 and mic90 of wr99210 in combination with dapsone we ...19968913480
localized cutaneous infection caused by mycobacterium avium complex in an aids patient.although infection due to mycobacterium avium complex (mac) has long been recognized, it was not until the current aids epidemic that isolation of these mycobacteria became common in microbiology laboratories. the disseminated form of the disease is the commonest type. localized disease as the first manifestation of mac infection is a rare finding among these patients. herein we report a case of localized cutaneous infection due to mac in an aids patient.19968914369
[the epidemiology of nontuberculous mycobacterial diseases in hiroshima prefecture].the patients of diseases caused by nontuberculous mycobacteria (ntm) newly diagnosed in 1993 in hiroshima prefecture were investigated retrospectively. during 1993, 59 newly diagnosed patients of ntm disease, who were the resident of hiroshima prefecture were reported from 6 hospitals. mycobacterium avium complex (mac) disease was most frequent (53 patients, 90%) and m. kansaii (mk) disease, which accounts for more than 20 percent of all the ntm diseases in the national survey of japan, was foun ...19968914386
azithromycin activity against mycobacterium avium complex lung disease in patients who were not infected with human immunodeficiency virus.we initiated a prospective trial of an azithromycin-containing regimen for the treatment of human immunodeficiency virus-negative patients with mycobacterium avium complex (mac) lung disease; the initial 4 months of therapy were with azithromycin (600 mg/d) alone. the primary study endpoint was microbiological response measured at 4 and 6 months of therapy. of 29 patients enrolled in the study, 23 completed therapy. fifty-two percent of these 23 patients were male, and 65% were smokers. all 23 p ...19968922790
intranasal infection of beige mice with mycobacterium avium complex: role of neutrophils and natural killer cells.beige mice show increased susceptibility to intranasal infection with organisms of the mycobacterium avium complex (mac) compared with their immunocompetent congenics, c57bl/6 mice. this increased susceptibility was clear 2 weeks postinfection, before the activation of the specific immune response. t lymphocytes from 4-week infected beige mice, cultured in vitro, produced amounts of gamma interferon similar to those found in cells from c57bl/6 mice. macrophage activation, as judged by no product ...19968926094
immune response & modulation of immune response induced in the guinea-pigs by mycobacterium avium complex (mac) & m. fortuitum complex isolates from different sources in the south indian bcg trial area.a total of 139 guineapigs were used to study the immune response and its modulation induced by mycobacterium avium complex (mac) and m. fortuitum complex strains obtained from different sources in the south indian bcg trial area. the guineapigs were divided into groups and some were directly sensitised/immunised with different mac strains. m. fortuitum complex strain or bcg and others were sensitised with mac or m. fortuitum complex and then immunised with bcg. the resulting delayed type hyperse ...19968935740
effect of ethambutol on emergence of clarithromycin-resistant mycobacterium avium complex in the beige mouse model.an animal model was developed for studying macrolide-resistant mycobacterium avium complex (mac) and to measure the effect of ethambutol on resistance. mac-infected beige mice were given clarithromycin daily; the frequency of clarithromycin-resistant mac after 8 and 12 weeks was 10(-3) and 10(-2), respectively. combined ethambutol plus clarithromycin did not increase anti-mac activity, but clarithromycin-resistant mac was less frequent (p < .05). the frequency of clarithromycin-resistant mac in ...19968940212
liposomal amikacin: improved treatment of mycobacterium avium complex infection in the beige mouse model.disseminated mycobacterium avium complex (mac) infection has reached epidemic proportions and is a major cause of morbidity and mortality in aids patients. we have developed a liposomal preparation of amikacin, vs107, which incorporates the drug in 54-65 nm diameter unilameller phospholipid vesicles and is stable at 4 degrees c for more than 4 months. vs107 exhibits superior microbiological and pharmacological activity over the free amikacin and improves the survival of mice in the established m ...19968961051
patterns of opportunistic infections in patients with hiv infection.the pattern of the development of opportunistic infections (ois) in hiv-infected patients was evaluated, based on a cohort of 1,530 patients enrolled in two aids clinical trials group anti-retroviral studies. we quantified the increase in risk of ois associated with the occurrence of a previous oi. this assessment was based on the observed event rates of the more common aids-defining ois: pneumocystis carinii pneumonia (pcp), mycobacterium avium complex (mac), cytomegalovirus (cmv), and a system ...19968624759
treatment of mycobacterium avium complex infection: do the results of in vitro susceptibility tests predict therapeutic outcome in humans?the ability of various in vitro methods of antibiotic susceptibility testing to predict therapeutic outcome in patients infected with mycobacterium avium complex (mac) was evaluated. pretreatment bloodstream mac isolates from 38 patients with aids, previously treated in a randomized fashion with either ethambutol, rifampin, or clofazimine, were tested by three conventional methods using broth or agar, as well as by cocultivation with macrophages. the results obtained with each method were compar ...19968627032
comparison of the e test and a proportion dilution method for susceptibility testing of mycobacterium avium complex.the newly developed e test was compared with an extended 1% proportion dilution method for determining the susceptibility of mycobacterium avium complex (mac) strains to amikacin, streptomycin, fusidic acid, rifampicin, clarithromycin, ciprofloxacin, ofloxacin and fleroxacin. for all antibiotics tested except clarithromycin and ciprofloxacin, no more than one strain gave a different susceptibility result with the two methods. the discrepant results occurred near the chosen breakpoint concentrati ...19968636943
mycobacterium avium-intracellulare complex pneumonia in a non-hiv-infected individual: an increasingly recognized disease.in the past, mycobacterium avium complex (mac) was considered a colonizing microbe in the immunocompetent host. today it should be considered a potential pathogen. we present a case of mac necrotizing pneumonia in a 27-year-old man who tested negatively for the human immunodeficiency virus, had no typical granulomas, and responded rapidly to antimicrobial therapy.19968638183
susceptibility testing of mycobacterium avium complex in clinical laboratories. results of a questionnaire and proficiency test performance by participants in the college of american pathologists mycobacteriology e survey.to obtain information regarding the frequency and methodology of susceptibility testing of mycobacterium avium complex (mac) in clinical microbiology laboratories, and to assess interlaboratory reproducibility of mac susceptibility testing.19968639045
multiple serovars of mycobacterium avium complex in patients with aids.mycobacterium avium complex (mac) was isolated and serotyped from 127 samples from 43 hiv-infected patients with disseminated disease in sweden. thirteen different serovars were observed. serovar 6 was the most common, followed by 4, 9 and 11. serovar 8 was rare. in 22 of the patients the same serovar was found in blood and at other sites. clinical symptoms and outcome were compared in patients with different serovars. analysis of patient records revealed no association between clinical picture ...19968645472
azithromycin in the prophylaxis of opportunistic infections in aids.prevention of opportunistic infections contributes to improved quality of life and survival in individuals with acquired immunodeficiency syndrome (aids). agents which are more effective and convenient, less costly, and better tolerated are needed for multiple organism primary prophylaxis. azithromycin, azalide with high and prolonged intracellular levels, promise to provide to protection against mycobacterium avium complex (mac) disease in those with advanced aids when given weekly. a large tra ...19968652726
extensive vascular calcification in a patient with perinatally acquired aids.extensive vascular calcification in an 8-year-old girl with perinatally acquired aids is reported. complicating factors included cardiomyopathy, chronic lung disease, disseminated mycobacterium avium complex (mac), and wasting syndrome with total nutrition dependence. plain abdominal films and ct of the abdomen immediately prior to her death revealed dense calcification of major vessels. autopsy revealed calcification in the media of most major vessels typical of hiv arteriopathy. a review of th ...19968657470
increased lung cell cytotoxic but not bactericidal or phagocytic activity in mycobacterium avium complex-infected mice.following intranasal infection of mice with mycobacterium avium complex (mac) organisms, bacterial growth plateaued at the fourth week postinfection and then remained relatively constant thereafter. inflammatory cell numbers in the lungs increased 10-fold by 4 weeks postinfection, and lung cell cytotoxicity and the production of no, h202, and 02- by lung cell cultures had all increased significantly by this time and remained elevated throughout the 15-week experimental study. although these para ...19968660836
costs of hiv+/aids at cd4+ counts disease stages based on treatment protocols.we report treatment protocols for hiv+/aids patients by cd4+ counts (t-lymphocyte cells/mm3: > or = 500, 499-200, 199-50, and < 50) as a tool to provide better definition and to project annual costs (total charges for services) and lifetimes costs for hiv+/aids. the treatment protocols, derived from the literature and an hiv+/aids physician panel, defined the resource use associated with antiretroviral therapy and opportunistic disease prophylaxis and treatment. resource use costs were derived f ...19968673552
the role of tumour necrosis factor-alpha in combination with interferon-gamma or interleukin-1 in the induction of immunosuppressive macrophages because of mycobacterium avium complex infection.the role of some cytokines including tumour necrosis factor-alpha (tnf-alpha), interleukin-1 alpha (il-1 alpha), interferon-gamma (ifn-gamma), transforming growth factor-beta (tgf-beta) and interleukin-6 (il-6) in the generation of immunosuppressive macrophages (m phi s) in host spleen cells of mycobacterium avium complex (mac)-infected mice was studied. m phi populations with potent suppressor activity against concanavalin a (con a)-induced mitogenesis of splenocytes (spcs) were elicited not on ...19968707352
rifabutin versus placebo in combination with three drugs in the treatment of nontuberculous mycobacterial infection in patients with aids.the aim of this double-blind, randomized, placebo-controlled, 12-week study was to assess the efficacy of rifabutin (450 or 600 mg/d) in the treatment of disseminated nontuberculous mycobacterial infection in patients with aids. companion drugs in both arms of the study were ethambutol, clofazimine, and isoniazid. because of low accrual, the study was prematurely terminated when a total of 382 patients had been enrolled, of which 200 were eligible (i.e., their specimens were culture-positive for ...19968729209
disseminated mycobacterium avium complex: correlation between blood and tissue burden.to determine the relationship between levels of mycobacterium avium complex (mac) in blood and tissues, histopathologic examination and quantitative mac cultures were done on blood samples and tissue samples of 7 organs at autopsy of 10 aids patients who had been treated for mac bacteremia. blood and tissue cultures were negative for mac for 3 of the patients and positive for 7. the numbers of mac colony-forming units in the blood and tissues were highly correlated. the highest concentrations of ...19968603975
mycobacterial complications of hiv infection.tuberculosis is the most common opportunistic infection worldwide and is caused by the only readily transmissible pathogen among persons with hiv infection. if treatment is initiated promptly and is supervised appropriately, cure, fortunately, is highly likely. isoniazid preventive therapy substantially reduces the risk of tuberculosis in persons with hiv infection. of the nontuberculous mycobacteria, mycobacterium avium complex (mac) is the most frequent cause of disease; however, disseminated ...19969016372
mycobacterium avium complex infection in mice: lack of exacerbation after lp-bm5 murine leukemia virus infection.the murine leukemia virus lp-bm5 has been used to reproduce the model of murine aids in order to evaluate the course of infection with the mo-1 strain of mycobacterium avium complex (mac). lp-bm5 was inoculated in c57bl/6 mice by intravenous (i.v.) injection either 8 weeks before an i.v. challenge with 10(3) or 10(6) cfu of mac (coinfection 1) or 10 days after an i.v. challenge with 10(3) cfu of mac (coinfection 2). during coinfection 2 experiments, the phenotypic alterations in blood lymphocyte ...19968606079
liver biopsy findings in 501 patients infected with human immunodeficiency virus (hiv).patients infected with human immunodeficiency virus (hiv) are at risk for a variety of liver diseases. we undertook a retrospective study of 501 hiv-seropositive patients to assess the yield of percutaneous liver biopsy. the most common indications for liver biopsy were liver test abnormalities (89.5%), fever for 2 weeks (71.9%), and hepatomegaly (52.0%). the most common biopsy-derived diagnosis was mycobacterium avium complex (mac), seen in 87 (17.4%) biopsies. mycobacterium tuberculosis was fo ...19968556399
association between hiv distal symmetric polyneuropathy and mycobacterium avium complex infection.pronounced infiltration of activated macrophages occurs in the peripheral nerves of patients with hiv distal symmetric polyneuropathy (dspn). mycobacterium avium complex (mac) is a common facultative intracellular parasite of the macrophage in advanced hiv disease and may induce macrophage activation. whether mac disease is associated with dspn was examined prospectively.19968971109
isolation and characterization of a 70 kda protein from mycobacterium avium.mycobacterium avium complex (mac) is an intracellular pathogen which causes disseminated bacterial infection in immunocompromised individuals. this organism predominantly infects macrophages. attachment of mac to macrophages is the first step prior to invasion. we have previously shown that a 70 kda protein of m. avium (ma) is one of nine monocyte-binding proteins. in the present study, we have purified this protein from sonic extracts of ma and studied some of its properties. the n-terminal seq ...19968971687
new developments in the treatment of nontuberculous mycobacterial (ntm) disease.until recently, therapy for most nontuberculous mycobacterial (ntm) disease, especially disease caused by mycobacterium avium-complex (mac), has been difficult and frustrating. the introduction of the newer macrolides (clarithromycin and azithromycin) has significantly added to the efficacy of regimens for both disseminated and pulmonary mac disease. clinical activity of these agents is lost when a mac isolate develops in-vitro resistance that is facilitated by use of the macrolides as single ag ...19968976583
uveitis associated with rifabutin therapy: a clinical alert.the incidence of mycobacterium avium complex (mac) infection is increasing among patients with aids. rifabutin therapy has been demonstrated to be effective in the treatment and prophylaxis of mac infection. over the past 3 years there have been several reports of uveitis associated with rifabutin therapy. the uveitis is almost always interior, begins unilaterally and progresses to involve both eyes. there is almost always a hypopyon present, and the uveitis progresses aggressively. it responds ...19968979664
evaluation of the etest for rapid susceptibility testing of mycobacterium avium to clarithromycin.mics of clarithromycin were determined by the etest method for thirty clinical strains of mycobacterium avium complex (mac) and compared with mics results as determined by the reference agar dilution method. agreement (within +/- 1 log2 dilution) between the etest and the reference method was 70% for susceptible strains and 100% for resistant strains. no major errors resulting in misclassification in susceptibility or resistance categories were detected for the etest mic method. it is suggested ...19968737150
genetic diversity among mycobacterium avium complex accuprobe-positive isolates.the partial 32-kda-protein gene sequences of 22 mycobacterium avium complex (mac) clinical isolates that were positive by the accuprobe mac probe only (not by the m. avium or m. intracellulare probe) were determined. the obtained nucleotide sequences were compared with the published sequences for m. tuberculosis, m. avium, and m. intracellulare by a sequence analysis program. there was a wide range of genetic diversity among the strains studied. most of them (16 of 22) had sequences similar but ...19968748272
pattern of utilization of rifabutin for prophylaxis of mycobacterium avium complex among patients with advanced human immunodeficiency virus disease in a community setting.to characterize the pattern of utilization, effectiveness, and safety profile of rifabutin for mycobacterium avium complex (mac) prophylaxis among individuals with advanced human immunodeficiency virus disease in a community setting.19968758106
clarithromycin prophylaxis against cryptosporidium enteritis in patients with aids.cryptosporidium enteritis (ce) in patients with acquired immunodeficiency syndrome (aids) can be a life-threatening opportunistic infection. a retrospective review of 471 charts of patients with aids in our clinic, prior to the availability of clarithromycin for the treatment of mycobacterium avium complex (mac), revealed that seven patients with cd4 counts < 25/mm3 developed ce. the median survival period from diagnosis to death in these patients was 10.6 days. the incidence of ce in patients w ...19968764523
interleukin-7 induces anti-mycobacterium avium activity in human monocyte-derived macrophages.to examine the modulatory role of interleukin (il)-7 on intracellular growth of mycobacterium avium complex (mac), human macrophages were treated either before or after mac infection with different concentrations of il-7. at 100 pg/ml, 1 ng/ml, and 10 ng/ml, treatment with il-7 before infection stimulated secretion of tumor necrosis factor-alpha (tnf-alpha) from mac-infected macrophages (increase up to 40%) and resulted in dose-dependent reduction in the number of intracellular bacteria. pretrea ...19968769616
species distribution in human immunodeficiency virus-related mycobacterial infections: implications for selection of initial treatment.management of mycobacterial infection is species specific; however, treatment is prompted by positive smears or cultures, often several weeks before species identification. the objective of this study was to determine the species distribution of mycobacterial isolates from various body sites in patients infected with human immunodeficiency virus (hiv). all mycobacterial isolates recovered at st. paul's hospital (vancouver, british columbia, canada) from april 1989 to march 1993 were reviewed. am ...19968783698
rifabutin prophylaxis for mycobacterium avium complex infection in patients with aids.rifabutin, a macrophage-penetrating lipophilic rifamycin, has a long half-life and activity in vitro against mycobacterium avium complex (mac). preliminary studies of patients with aids and those with aids-related complex defined dose-limiting toxic effects (arthralgia/arthritis and uveitis) and suggested that rifabutin alone might reduce the incidence of mac infections. two double-blind, randomized, placebo-controlled trials involving 1,100 subjects confirmed the safety and efficacy of low dose ...19968785252
antimicrobial activity of rifabutin.rifabutin is a spiro-piperidyl-rifamycin derived from rifamycin-s. it is structurally related to rifampin and shares many of its properties. rifabutin has a broad spectrum of antimicrobial activity. it is considerably more active than rifampin in vitro against the mycobacterium avium complex (mac), mycobacterium tuberculosis, and mycobacterium leprae. it also is active against most atypical mycobacteria, including mycobacterium kansasii, but mycobacterium chelonae is relatively resistant. rifabu ...19968785253
rifabutin in the treatment of mycobacterium avium complex infection: experience in europe.several european clinical trials of rifabutin alone or in multidrug regimens for treatment of infections due to mycobacterium avium complex (mac) in patients with aids are discussed. a prospective open study in france assessed 50 patients treated with the combination rifabutin/ isoniazid/ethambutol/clofazimine. treatment was well tolerated, and the rate of conversion of cultures (from positive to negative) was 70% at 6 months. a randomized, double-blind, placebo-controlled, prospective trial (th ...19968785254
rifabutin therapy for disseminated mycobacterium avium complex infection.although numerous antimicrobial agents have been used to treat disseminated mycobacterium avium complex (mac) infection, the optimal therapy for this disease is unknown. one potentially effective agent is rifabutin, which has demonstrated activity against mac both in vitro and in animal models of infection. in clinical trials, cultures of blood from 46% to 92% of patients become sterile after therapy with rifabutin combined with ethambutol, clofazimine, or amikacin. moreover, the efficacy of eth ...19968785255
mycobacterium avium complex infection, rifabutin, and uveitis--is there a connection?rifabutin, an antimycobacterial agent, has been recommended by the u.s. public health service as prophylaxis against infection due to mycobacterium avium complex (mac) in patients with aids. when rifabutin is administered as prophylaxis, uveitis has been reported only rarely. however, uveitis has been reported in two studies in which rifabutin was administered at higher doses in combination with an azole, a macrolide, or both for treatment of disseminated mac infection. the uveitis that has been ...19968785256
recent development in the treatment and prevention of disseminated mycobacterium avium complex (mac).disseminated mycobacterium avium complex (dmac) is the third most common opportunistic infection in people with aids, infecting up to 50 percent of them. symptoms include high fever, weight loss, fatigue, diarrhea, poor appetite, night sweats, and anemia. diagnosis is by blood culture. results of two recent studies are presented, as well as treatment guidelines issued by a national panel.199611364267
[the new age of hiv/aids. a special report on the xi international conference on aids].new treatments that are available promoted optimism at the xi international conference on aids, held in vancouver in july 1996. topics that were presented at the conference are highlighted, including a global analysis of the epidemic, possible eradication of the virus, pathogenesis of the hiv virus, detection of the viral load change in the blood, and the status of protease inhibitors. a brief report on the combination and activity of crixivan, azt and 3tc is presented. the dangers of opportunis ...199611364380
icaac: what else is new?three hiv-related topics were discussed at the 1995 interscience conference on antimicrobial agents and chemotherapy. 1) protease inhibitors given in high doses are able to delay resistance, even when given as monotherapy. combination therapies are more successful than monotherapies, and triple combinations are more effective than double combinations. 2) a cytomegalovirus (cmv) vaccine was well-tolerated and effective in healthy cmv-immune adults. a phase iii clinical trial found valaciclovir, a ...199611363114
early intervention and prevention options.in july 1993, the united states public health service and the infectious disease society of america gave a set of recommendations for early intervention and prevention of opportunistic infections in hiv-positive people. these guidelines follow cd4 counts. according to the guidelines, cd4 counts above 500 should be monitored every 4 to 6 months and screenings for tuberculosis, sexually transmitted diseases, and other diseases should also be done. at a cd4 count of 75, a prophylaxis of rifabutin a ...199611363117
australia reports on aids: nef deletions, live vaccines, chinese travelers.australian research shows that individuals who share hiv nef deletions and adjacent sequences in the long terminal repeat (ltr) segment of the viral genome may indicate a weakening of the virus. a cluster of long-term survivors who share this enfeebled virus has contributed to the attenuated hiv vaccine debate. the debate was discussed at the seventh annual australian conference for hiv medicine. the story began when a researcher discovered a relationship between a gay male blood donor and five ...199611363347
clarithromycin for mac prevention offers additional benefits.the use of clarithromycin in preventing mycobacterium avium complex (mac) may also prevent a number of other opportunistic infections in aids patients. a large multinational study showed a reduction in pneumocystis carinii pneumonia (pcp), community-acquired pneumonia (cap), and giardiasis, an intestinal disorder. the study involved participants with cd4 counts below 100.199611363431
hold the big mac.the retrovirus conference provided information on two studies that examine the prevention of mycobacterium avium complex (mac). people with an active infection run fevers, lose weight, and have no appetite. rifabutin is currently the only drug with food and drug administration (fda) approval for the prevention of mac. it was found to be most effective in combination with azithromycin, but because the two drugs are chemically similar, resistance to both is a threat. thirty percent of the people t ...199611363450
progress report: prophylaxis and therapy for mac.study efforts are showing progress in the prevention and therapy of mycobacterium avium complex (mac) infection. a review of recent study developments highlights clinical findings on prophylactic use of rifabutin, clarithromycin, and azithromycin, used both as monotherapies and as combination therapies. three tables highlight study results from mac prophylaxis studies, mac treatment studies, and candidate regimens for mac prophylaxis in aids. treatment of disseminated mac is also addressed. the ...199611363599
missed tb in aids unit leads to tighter isolation.the san francisco general hospital recently tightened its tuberculosis (tb) policies for isolating hiv-positive patients after learning that active tb patients had been admitted without respiratory protection. the new policy resulted from what was initially believed to be a tb outbreak on the aids unit. however, an investigation concluded that the patients were infected outside the hospital. the hospital now automatically screens patients for tb when they are admitted to the aids ward. hiv-posit ...199611363656
old drug approved for mac prevention.the food and drug administration (fda) approved the broad-spectrum antibiotic azithromycin for prevention of mycobacterium avium complex (mac) in people with advanced hiv disease. the treatment offers flexibility in that it can be taken once a week. clinical trials show that 1200 mg of azithromycin taken weekly reduced the risk of developing mac bacteria in the bloodstream. in a large double-blind study, the drug was more effective than rifabutin in preventing mac. a combination of azithromycin ...199611363659
mac prophylaxis revisited.mycobacterium avium complex (mac) infection occurs in 18 to 40 percent of people with aids, and most commonly in those with cd4 counts under 50. mac is a difficult infection to diagnose, as its symptoms mimic many other infections and tumors. mac infections can occur in the respiratory system or gastrointestinal tract, and the infection may spread through the bloodstream. clinical trials for mac prophylaxis include clarithromycin, rifabutin, or a combination of both. the individual drugs and the ...199611363706
antivirals key to mac prevention regimen.prophylaxis for mycobacterium avium complex (mac) should be considered standard treatment for all patients with advanced hiv disease. mac is the most common bacterial infection that affects aids patients. there are three effective agents that significantly reduce the risk of mac--rifabutin, clarithromycin, and azithromycin. mac prophylaxis is cost-effective, improves the quality of a patient's life, and improves overall survival by 25 to 32 percent.199611363722
high-dose clarithromycin should be avoided.high dosages of clarithromycin used to prevent mycobacterium avium complex (mac) in aids patients unexpectedly increased their risk of death. health officials are alerting clinicians to lower the prescribed doses. the new recommended dose is 500 mg. patients who took 1,000 mg twice a day experienced lower survival rates in the cpcra 009 clinical trial. the results were surprising and counterintuitive, and underscore the importance of having clinical endpoints in a trial rather than just dependin ...199611363723
or is it the host, sir?scientists at the ninth international symposium on infections in the immunocompromised host offered evidence that the rate of hiv disease progression may be determined by how vigorously host defenses are mobilized in the first weeks of infection. others report on the use of thalidomide or il-10 for curtailing or suppressing tumor necrosis factor alpha in coincident hiv and tuberculosis patients. the success of shoring up weakened host defenses against the onslaught of opportunistic pathogens, su ...199611363895
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