Clinical investigation of pulmonary Mycobacterium avium complex infection in human T lymphotrophic virus type I carriers

• Published in: Thorax Vol. 55; no. 5; pp. 388 - 392
• Main Author: Matsuyama, W.
• Format: Journal Article
• Language: English
• Published: London BMJ 01.05.2000; BMJ Group
• Subjects: Aged; Biological and medical sciences; Bronchoalveolar Lavage Fluid; Bronchoalveolar Lavage Fluid - immunology; Carrier State; Carrier State - immunology; Cytokines; Cytokines - analysis; Deltaretrovirus Infections; Deltaretrovirus Infections - complications; Deltaretrovirus Infections - immunology; Female; Human viral diseases; Humans; Infectious diseases; Lung Diseases; Lung Diseases - complications; Lung Diseases - diagnostic imaging; Male; Medical sciences; Middle Aged; Mycobacterium avium-intracellulare Infection; Mycobacterium avium-intracellulare Infection - complications; Mycobacterium avium-intracellulare Infection - diagnostic imaging; Opportunistic Infections; Opportunistic Infections - complications; Opportunistic Infections - diagnostic imaging; Original; Simian T-lymphotropic virus 1; Tomography, X-Ray Computed; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Human; Lung disease; Pneumonia; Radiodiagnosis; Pathophysiology; Respiratory disease; Retroviridae; Mycobacterium avium; Exploration; Mycobacterial infection; Infection; Virus; Radiography; Mycobacteriales; Bronchoalveolar lavage; Viral disease; Bacteriosis; Mycobacteriaceae; Bacteria; Actinomycetes; HTLV-I virus; Comparative study
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax.55.5.388

Little is known about pulmonary Mycobacterium avium complex (MAC) infection in human T lymphotrophic virus type I (HTLV-I) carriers. A study was undertaken to investigate and clarify the characteristics of pulmonary MAC infection in these subjects. Twenty nine patients with pulmonary MAC infection without any underlying pulmonary disorder were investigated. The clinical features and radiographic appearance of HTLV-I carriers and non-carriers were compared and the bronchoalveolar lavage (BAL) fluid of these 29 patients and eight normal female control subjects was analysed. The prevalence of the HTLV-I carrier state in patients with pulmonary MAC infection was 34.5% (10/29) compared with 16.7% (529/3169) among all patients admitted to our department between 1994 and 1998 (odds ratio (OR) 2.63, 95% confidence interval (CI) 1.21 to 5.68). The HTLV-I carriers were all women and all had clinical symptoms, but they did not show systemic dissemination. Peripheral multifocal bronchiectasis with nodular shadowing was seen frequently on the chest computed tomographic (CT) scans of HTLV-I carriers. The area of the pulmonary lesions was more extensive than in non-carriers (p<0.05). White blood cell (WBC) counts and C reactive protein (CRP) levels on admission were significantly lower in HTLV-I carriers than in non-carriers (WBC: difference (D) = 1565/microl, 95% CI -68.9 to 3198.4/microl; CRP: D = 1.8 mg/dl, 95% CI -0.35 to 3.89 mg/dl). The concentrations of neutrophil elastase (NE) and interleukin (IL)-8 in BAL fluid were significantly higher in HTLV-I carriers than in non-carriers (NE: D = 1342 microg/l, 95% CI 704 to 1980.3 microg/l; IL-8: D = 304.5 pg/ml, 95% CI 89.7 to 519. 4 pg/ml). Pulmonary MAC infection causes more diffuse and widespread lesions in HTLV-I carriers than in non-carriers.