Pathologic features of Mycobacterium kansasii infection in patients with acquired immunodeficiency syndrome

Michael B. Smith, Claudia P. Molina, Vicki J. Schnadig, Michael Boyars, Judith Aronson

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Context - Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium that may infect patients with human immunodeficiency virus (HIV) late in the course of acquired immunodeficiency syndrome (AIDS). The clinical features of pulmonary and extrapulmonary infections have been described in the literature; however, the pathology of infection has not been adequately addressed. Objective - This report describes the pathologic features of 12 cases of M kansasii infection in patients with AIDS. Design - The medical records, autopsy protocols, cytologic material, and histologic material from patients with AIDS and concomitant M kansasii infection at a tertiary-care medical center during 1990-2001 were reviewed. Results - Twelve cases were identified, 6 by autopsy, 5 of which were diagnosed postmortem. Four of the 12 cases had cytologic material and 4 cases had histologic biopsies available for review. Pulmonary infection was most common (9/12), and all patients in whom thoracic lymph nodes were assessed showed involvement (7/7). Abdominal infection was less frequent, with only 1 of 6, 2 of 6, and 2 of 6, demonstrating liver, spleen, and abdominal lymph node infection, respectively. Isolated infections without documented pulmonary infection included brain abscess (n = 1), ulnar osteomyelitis (n = 1), and paratracheal mass (n = 1). Cytologic and histologic material showed a wide range of inflammatory reactions, including granulomas with and without necrosis, neutrophilic abscesses, spindle-cell proliferations, and foci of granular eosinophilic necrosis. The M kansasii bacillus was characteristically long, coarsely beaded, and frequently showed folded, bent, or curved ends. Intracellular bacilli were randomly or haphazardly distributed within histiocytes. Conclusion - Mycobacterium kansasii infection produces predominately pulmonary infection in late-stage AIDS with a high incidence of thoracic lymph node involvement and a much lower incidence of dissemination to other sites. Infection is manifest as a wide variety of inflammatory reactions on cytology and histology; however, the characteristic appearance of the bacillus on acid-fast bacilli stain and its intracellular arrangement in histiocytes can allow a presumptive identification.

Original languageEnglish (US)
Pages (from-to)554-560
Number of pages7
JournalArchives of Pathology and Laboratory Medicine
Volume127
Issue number5
StatePublished - May 1 2003

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Mycobacterium kansasii
Mycobacterium Infections
Acquired Immunodeficiency Syndrome
Infection
Bacillus
Lung
Histiocytes
Lymph Nodes
Autopsy
Necrosis
Thorax
Brain Abscess
Incidence
Osteomyelitis
Mycobacterium
Granuloma
Tertiary Care Centers
Abscess
Medical Records
Cell Biology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

Pathologic features of Mycobacterium kansasii infection in patients with acquired immunodeficiency syndrome. / Smith, Michael B.; Molina, Claudia P.; Schnadig, Vicki J.; Boyars, Michael; Aronson, Judith.

In: Archives of Pathology and Laboratory Medicine, Vol. 127, No. 5, 01.05.2003, p. 554-560.

Research output: Contribution to journalArticle

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abstract = "Context - Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium that may infect patients with human immunodeficiency virus (HIV) late in the course of acquired immunodeficiency syndrome (AIDS). The clinical features of pulmonary and extrapulmonary infections have been described in the literature; however, the pathology of infection has not been adequately addressed. Objective - This report describes the pathologic features of 12 cases of M kansasii infection in patients with AIDS. Design - The medical records, autopsy protocols, cytologic material, and histologic material from patients with AIDS and concomitant M kansasii infection at a tertiary-care medical center during 1990-2001 were reviewed. Results - Twelve cases were identified, 6 by autopsy, 5 of which were diagnosed postmortem. Four of the 12 cases had cytologic material and 4 cases had histologic biopsies available for review. Pulmonary infection was most common (9/12), and all patients in whom thoracic lymph nodes were assessed showed involvement (7/7). Abdominal infection was less frequent, with only 1 of 6, 2 of 6, and 2 of 6, demonstrating liver, spleen, and abdominal lymph node infection, respectively. Isolated infections without documented pulmonary infection included brain abscess (n = 1), ulnar osteomyelitis (n = 1), and paratracheal mass (n = 1). Cytologic and histologic material showed a wide range of inflammatory reactions, including granulomas with and without necrosis, neutrophilic abscesses, spindle-cell proliferations, and foci of granular eosinophilic necrosis. The M kansasii bacillus was characteristically long, coarsely beaded, and frequently showed folded, bent, or curved ends. Intracellular bacilli were randomly or haphazardly distributed within histiocytes. Conclusion - Mycobacterium kansasii infection produces predominately pulmonary infection in late-stage AIDS with a high incidence of thoracic lymph node involvement and a much lower incidence of dissemination to other sites. Infection is manifest as a wide variety of inflammatory reactions on cytology and histology; however, the characteristic appearance of the bacillus on acid-fast bacilli stain and its intracellular arrangement in histiocytes can allow a presumptive identification.",
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